Provider Demographics
NPI:1245543297
Name:ACTIVE PHYSICAL THERAPY, INC.
Entity type:Organization
Organization Name:ACTIVE PHYSICAL THERAPY, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICER, DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:RAYMOND
Authorized Official - Last Name:VANWYE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:614-850-0500
Mailing Address - Street 1:PO BOX 1267
Mailing Address - Street 2:
Mailing Address - City:HILLIARD
Mailing Address - State:OH
Mailing Address - Zip Code:43026-6267
Mailing Address - Country:US
Mailing Address - Phone:614-850-0500
Mailing Address - Fax:614-850-0540
Practice Address - Street 1:5551 HILLIARD ROME OFFICE PARK
Practice Address - Street 2:
Practice Address - City:HILLIARD
Practice Address - State:OH
Practice Address - Zip Code:43026-7287
Practice Address - Country:US
Practice Address - Phone:614-850-0500
Practice Address - Fax:614-850-0540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-20
Last Update Date:2014-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH011509225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0053207Medicaid
OH9391101Medicare UPIN