# ACTIVE REHAB, LLC

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

## Provider details

- **NPI number:** 1508383324
- **Authorized official:** CAROLINE VIDENA (ADMINISTRATOR)
- **Authorized official phone:** (925) 785-0872

## Contact information

- **Practice address:** 2520 HORSESHOE DR, SANTA ROSA, CA 95405-8144
- **Practice address phone:** (925) 785-0872
- **Mailing address:** 2520 HORSESHOE DR, SANTA ROSA, CA 95405-8144
- **Mailing address phone:** 19257850872

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225100000X | Physical Therapist | 38866 | CA | Yes |

## Other

- **Enumeration date:** 08/23/2017
- **Last updated:** 08/23/2017