Provider Demographics
NPI:1538862552
Name:ACTIVECARE ULTIMATE PHYSICAL THERAPY
Entity type:Organization
Organization Name:ACTIVECARE ULTIMATE PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:RIK
Authorized Official - Middle Name:
Authorized Official - Last Name:COUWENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:973-366-4000
Mailing Address - Street 1:600 MOUNT PLEASANT AVE STE F
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:NJ
Mailing Address - Zip Code:07801-1621
Mailing Address - Country:US
Mailing Address - Phone:973-891-1080
Mailing Address - Fax:
Practice Address - Street 1:27 US HIGHWAY 202 STE 5
Practice Address - Street 2:
Practice Address - City:FAR HILLS
Practice Address - State:NJ
Practice Address - Zip Code:07931-7001
Practice Address - Country:US
Practice Address - Phone:908-375-8881
Practice Address - Fax:908-375-8890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-27
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy