Provider Demographics
NPI:1154376820
Name:ACTIVE LIFE PHYSICAL THERAPY, INC.
Entity type:Organization
Organization Name:ACTIVE LIFE PHYSICAL THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NIKHIL
Authorized Official - Middle Name:D
Authorized Official - Last Name:NADKARNI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-364-0849
Mailing Address - Street 1:45149 PAWNEE DR
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94539-6663
Mailing Address - Country:US
Mailing Address - Phone:510-364-0849
Mailing Address - Fax:
Practice Address - Street 1:24301 SOUTHLAND DR
Practice Address - Street 2:SUITE #411
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94545-1542
Practice Address - Country:US
Practice Address - Phone:510-732-6495
Practice Address - Fax:510-732-6551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2007-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ02377ZMedicare PIN