Organization Name: | ACTIVE EDGE PHYSICAL THERAPY, LLC |
NPI Number: | 1043685068 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | DANIEL C MORLAN (MANAGING PARTNER) |
Mailing Address: | 19727 South Highway 213 Oregon City |
State: | OR US |
Postal Code: | 97045 |
Phone Number: | 5033875449 |
Fax Number: | 5033426846 |
NPI Enumeration Date: | 12/02/2015 |
NPI Last Update Date: | 12/02/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 2251X0800X |
License Number: | 04568 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OR |
Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
Taxonomy Classification: | Physical Therapist |
Taxonomy Specialization: | Orthopedic |
Taxonomy Definition: |