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Organization
ACTIVE REHAB, LLC
Active
Organization
ACTIVE REHAB, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CAROLINE VIDENA (ADMINISTRATOR)
(925) 785-0872
Entity
Organization
Contact information
Practice address
2520 HORSESHOE DR, SANTA ROSA, CA 95405-8144
(925) 785-0872
Mailing address
2520 HORSESHOE DR, SANTA ROSA, CA 95405-8144
19257850872
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
38866
CA
Other
Enumeration date
08/23/2017
Last updated
08/23/2017
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