Active Life Physical Therapy & Rehab Inc is a medicare enrolled "Clinic/center - Physical Therapy" provider in Southfield, Michigan. Their current practice location is
17515 W 9 Mile Rd Ste 140, Southfield, Michigan. You can reach out to their office (for appointments etc.) via phone at
(248) 281-4097.
Active Life Physical Therapy & Rehab Inc is licensed to practice in Michigan (license number 5501014085) and it also participates in the medicare program. Active Life Physical Therapy & Rehab Inc
is enrolled with medicare and should accept medicare assignments and since they are enrolled in medicare, they may order Medicare Part D Prescription drugs, if eligible. The facility's NPI Number is 1073016614.
Healthcare Provider's Profile
| Full Name | Active Life Physical Therapy & Rehab Inc |
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| Type | Facility |
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| Speciality | Clinic/center - Physical Therapy |
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| Location | 17515 W 9 Mile Rd Ste 140, Southfield, Michigan |
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| Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1073016614
- Provider Enumeration Date: 03/09/2018
- Last Update Date: 01/15/2025
Medicare PECOS Information:
- PECOS PAC ID: 6800323023
- Enrollment ID: O20241227002958
Medical Identifiers
Medical identifiers for Active Life Physical Therapy & Rehab Inc such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
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| 1073016614 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 225100000X | Physical Therapist | (* (Not Available)) | Secondary |
| 261QP2000X | Clinic/center - Physical Therapy | 5501014085 (Michigan) | Primary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works.
Active Life Physical Therapy & Rehab Inc acts as a billing entity for following providers:
| Provider Name | Sidharth Anneboina |
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| Provider Type | Practitioner - Physical Therapist In Private Practice |
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| Provider Identifiers | NPI Number: 1659683407
PECOS PAC ID: 3678809233
Enrollment ID: I20190719002546 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Active Life Physical Therapy & Rehab Inc is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
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Active Life Physical Therapy & Rehab Inc
27320 Debiasi Dr,
Brownstown, MI 48174-8511
Ph: () - | Active Life Physical Therapy & Rehab Inc
17515 W 9 Mile Rd Ste 140,
Southfield, MI 48075-4411
Ph: (248) 281-4097 |
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