Provider Demographics
NPI:1992055586
Name:ACTIVE RECOVERY PHYSICAL REHABILITATION AND WELLNESS
Entity type:Organization
Organization Name:ACTIVE RECOVERY PHYSICAL REHABILITATION AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHERWIN
Authorized Official - Middle Name:R
Authorized Official - Last Name:SANTOS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:201-661-0911
Mailing Address - Street 1:22 CARNATION ST
Mailing Address - Street 2:
Mailing Address - City:BERGENFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07621-3802
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:22 CARNATION ST
Practice Address - Street 2:
Practice Address - City:BERGENFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07621-3802
Practice Address - Country:US
Practice Address - Phone:201-661-0911
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-11
Last Update Date:2012-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA07859225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty