1578880381 NPI number — BEE ACTIVE, LLC

Table of content: (NPI 1578880381)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578880381 NPI number — BEE ACTIVE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BEE ACTIVE, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1578880381
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/20/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
245 PLEASANT POINTE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEXINGTON
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40517-4477
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
865-809-2483
Provider Business Mailing Address Fax Number:
859-268-8507

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
245 PLEASANT POINTE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEXINGTON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40517-4477
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-809-2483
Provider Business Practice Location Address Fax Number:
859-268-8507
Provider Enumeration Date:
05/03/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HENDERSON
Authorized Official First Name:
AMBER
Authorized Official Middle Name:
NOEL
Authorized Official Title or Position:
DOCTORATE OF PHYSICAL THERAPY
Authorized Official Telephone Number:
865-809-2483

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PT005482 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 252Y00000X , with the licence number: 005482 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1245563428 . This is a "INDIVIDUAL NPI" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".