Organization
ACTIVE LIFE SPINE & JOINT CLINIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RONALD SAMANIEGO PT (OWNER)
(224) 425-0548
Entity
Organization
Contact information
Practice address
3600 E STATE ST STE 222, ROCKFORD, IL 61108-1956
(224) 425-0548
Mailing address
3600 E STATE ST STE 222, ROCKFORD, IL 61108-1956
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Enumeration date
01/08/2019
Last updated
01/08/2019
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