Provider Demographics
NPI:1932924602
Name:ACTIVE PHYSICAL THERAPY WELLNESS CENTER
Entity type:Organization
Organization Name:ACTIVE PHYSICAL THERAPY WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:J
Authorized Official - Last Name:PAUSER
Authorized Official - Suffix:
Authorized Official - Credentials:PT,DPT
Authorized Official - Phone:760-638-1448
Mailing Address - Street 1:2790 N ACADEMY BLVD STE 110
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80917-5307
Mailing Address - Country:US
Mailing Address - Phone:719-636-3080
Mailing Address - Fax:
Practice Address - Street 1:2790 N ACADEMY BLVD STE 110
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80917-5307
Practice Address - Country:US
Practice Address - Phone:760-638-1448
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-18
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty