| Organization Name: | ACTIVE LIFE PHYSICAL THERAPY LTD |
| NPI Number: | 1326421074 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | CONSTANTINE BOLOS (PRESIDENT) |
| Mailing Address: | 3620 Edison Pl Rolling Meadows |
| State: | IL US |
| Postal Code: | 600081037 |
| Phone Number: | 8473237001 |
| Fax Number: | |
| NPI Enumeration Date: | 06/30/2015 |
| NPI Last Update Date: | 06/30/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Physical Therapy |
| Taxonomy Definition: | |