Provider Demographics
NPI:1063281145
Name:PROACTIVE PT LLC
Entity type:Organization
Organization Name:PROACTIVE PT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HOME HEALTH PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:SURUCH
Authorized Official - Middle Name:RASHMIKANT
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:214-606-4154
Mailing Address - Street 1:77 SHERMAN PL APT 3
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07307-3733
Mailing Address - Country:US
Mailing Address - Phone:214-606-4154
Mailing Address - Fax:
Practice Address - Street 1:1480 WILLIAMSBRIDGE RD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-2505
Practice Address - Country:US
Practice Address - Phone:214-606-4154
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-29
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty