Organization
ACTIVENW, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
HANNAH MORRIS (MANAGING OWNER)
(208) 215-2210
Entity
Organization
Contact information
Practice address
301 N 3RD ST, COEUR D ALENE, ID 83814
(208) 772-8557
Mailing address
301 N 3RD ST, COEUR D ALENE, ID 83814-2861
(208) 215-2210
(208) 215-2209
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Enumeration date
01/10/2018
Last updated
03/12/2020
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