# ACTIVE SPINE & REHAB, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1427609429
- **Authorized official:** PATRICK MURRAY (DIRECTOR OF REVENUE CYCLE)
- **Authorized official phone:** (410) 970-8190

## Contact information

- **Practice address:** 802 CROMWELL PARK DR, GLEN BURNIE, MD 21061-2563
- **Practice address phone:** (410) 970-8190
- **Practice address fax:** (410) 313-8314
- **Mailing address:** 10753 BIRMINGHAM WAY, WOODSTOCK, MD 21163-1535
- **Mailing address phone:** (410) 970-8190

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM1300X | Multi-Specialty Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 09/23/2019
- **Last updated:** 09/23/2019