Organization
ACTIVE PHYSICAL THERAPY AND WELLNESS PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RICKY JOHN BASTARACHE DPT (PRESIDENT)
(810) 694-1037
Entity
Organization
Contact information
Practice address
5430 S SAGINAW RD, FLINT, MI 48507-4464
(810) 694-1037
Mailing address
5430 S SAGINAW RD, FLINT, MI 48507-4464
(810) 694-1037
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
5501007536
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4849415
—
MI
Enumeration date
07/08/2006
Last updated
08/22/2020
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