Provider Demographics
NPI:1902628050
Name:ACTIVE DC PHYSIOTHERAPY LLC
Entity type:Organization
Organization Name:ACTIVE DC PHYSIOTHERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HR GENERALIST / CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:JEWEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MCSWAIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-788-9516
Mailing Address - Street 1:818 18TH ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20006-3513
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:818 18TH ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20006-3513
Practice Address - Country:US
Practice Address - Phone:202-780-1663
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-29
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty