| Organization Name: | ACTIVE HEALTHCARE MEDICAL GROUP INC |
| NPI Number: | 1699955575 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MIGUEL DOMINGO (MEDICAL DIRECTOR) |
| Mailing Address: | 512 S Glendora Ave West Covina |
| State: | CA US |
| Postal Code: | 917903022 |
| Phone Number: | 6263372888 |
| Fax Number: | |
| NPI Enumeration Date: | 11/08/2007 |
| NPI Last Update Date: | 03/11/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| 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 |