| Organization Name: | PRO ACTIVE ADVANTAGE, LLC |
| NPI Number: | 1124148176 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | FRANK J KNIGHT (CEO) |
| Mailing Address: | 2223 Overland Ave Burley |
| State: | ID US |
| Postal Code: | 833182929 |
| Phone Number: | 2088783423 |
| Fax Number: | 2088783424 |
| NPI Enumeration Date: | 03/30/2007 |
| NPI Last Update Date: | 02/16/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TR0400X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Rehabilitation |
| Taxonomy Definition: | |