Organization
ACTIVELIFE WELLNESS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHAYNA IACOVIELLO (BILLING MANAGER)
(732) 935-1000
Entity
Organization
Contact information
Practice address
5181 MARINER BLVD, SPRING HILL, FL 34609-1834
(732) 935-1000
Mailing address
5181 MARINER BLVD, SPRING HILL, FL 34609-1834
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PT38241
STATE LICENSE
FL
Enumeration date
03/16/2022
Last updated
03/16/2022
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