Provider Demographics
NPI:1316145709
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:VICE PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:DAYNA
Authorized Official - Middle Name:
Authorized Official - Last Name:WEARY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-778-2227
Mailing Address - Street 1:980 WILLOW CREEK RD
Mailing Address - Street 2:#104
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86301
Mailing Address - Country:US
Mailing Address - Phone:928-778-2227
Mailing Address - Fax:928-771-9159
Practice Address - Street 1:955 BLACK DRIVE
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86305
Practice Address - Country:US
Practice Address - Phone:928-778-2227
Practice Address - Fax:928-771-9159
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy