Organization · NPI-2

Active Life Physical Therapy & Rehab INC

Clinic/Center, Physical Therapy · Southfield, MI

NPI number1073016614
StatusActive
Last updated in NPPESJan 15, 2025

Details

NPI
1073016614
Entity type
Organization (NPI-2)
Legal business name
Active Life Physical Therapy & Rehab INC
Organization subpart
No
Enumeration date
Mar 9, 2018
Certification date
Jan 15, 2025
Last updated
Jan 15, 2025

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
261QP2000X Clinic/Center, Physical Therapy5501014085MIYes
225100000X Physical Therapist––

Practice location

17515 W 9 Mile Rd Ste 140
Southfield, MI 48075-4411

Phone 248-281-4097

Mailing address

27320 Debiasi Dr
Brownstown, MI 48174-8511

Other practice locations

27320 Debiasi Dr
Brownstown, MI 48174-8511

Phone 734-637-7540

Authorized official

Raj Nijjar
Ceo
7346377540

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