| Organization Name: | ACTIVE LIFE & SPORTS THERAPY LLC |
| NPI Number: | 1396836052 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MICHAEL DAVID WAH (PRESIDENT/OWNER) |
| Mailing Address: | 4337 Ebenezer Rd Nottingham |
| State: | MD US |
| Postal Code: | 212362143 |
| Phone Number: | 4105293303 |
| Fax Number: | 4105297980 |
| NPI Enumeration Date: | 09/27/2006 |
| NPI Last Update Date: | 01/12/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | 15366 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MD |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |