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Organization
ACTIVE THERAPY MN
Active
Organization
ACTIVE THERAPY MN
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHELDON HOLLANDER (MANAGING MEMBER)
(612) 562-8204
Entity
Organization
Contact information
Practice address
10300 HENNEPIN TOWN RD, EDEN PRAIRIE, MN 55347-5100
(612) 562-8204
(763) 328-0111
Mailing address
6633 N LINCOLN AVE, LINCOLNWOOD, IL 60712-3605
(612) 562-8204
(763) 328-0111
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
NULL
225100000X
Physical Therapist
Primary
—
—
225X00000X
Occupational Therapist
—
NULL
225X00000X
Occupational Therapist
—
—
235Z00000X
Speech-Language Pathologist
—
NULL
235Z00000X
Speech-Language Pathologist
—
—
Other
Enumeration date
02/23/2022
Last updated
03/22/2022
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