# ACTIVE LIFE PHYSICAL THERAPY CENTER INC

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

## Provider details

- **NPI number:** 1962565291
- **Authorized official:** MR. PATRICK W DODGEN PT (PHYSICAL THERAPIST)
- **Authorized official phone:** (541) 412-3717

## Contact information

- **Practice address:** 616 HEMLOCK STREET, A, BROOKINGS, OR 97415-9412
- **Practice address phone:** (541) 412-1155
- **Mailing address:** PO BOX 1628, BROOKINGS, OR 97415-0039

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QP2000X | Physical Therapy Clinic/Center | 3572 | OR | Yes |

## Other

- **Enumeration date:** 12/18/2006
- **Last updated:** 10/22/2007