Provider Demographics
NPI:1285778233
Name:ACTIVE CARE PHYSICAL THERAPY & SPORTS MEDICINE, INC
Entity type:Organization
Organization Name:ACTIVE CARE PHYSICAL THERAPY & SPORTS MEDICINE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:ZELUS
Authorized Official - Last Name:UNDERHILL
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:310-543-4727
Mailing Address - Street 1:4201 TORRANCE BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-4504
Mailing Address - Country:US
Mailing Address - Phone:310-543-4727
Mailing Address - Fax:310-543-0567
Practice Address - Street 1:4201 TORRANCE BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-4504
Practice Address - Country:US
Practice Address - Phone:310-543-4727
Practice Address - Fax:310-543-0567
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty