ACTIVEDGE FITNESS AND SPORTS PERFORMANCE, INC. (NPI# 1326474420) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1326474420 |
| Entity Type | Organization |
| Organization Name | ACTIVEDGE FITNESS AND SPORTS PERFORMANCE, INC. |
| Practice Address |
4221 Garrett Rd Suite 1-2 Durham NC 27707-3467 |
| Practice Telephone | 9194931204 |
| Practice Fax Number | 9194931204 |
| Mailing Telephone | 9194931204 |
| Mailing Fax Number | 9194931204 |
| Enumeration Date | 2013-09-20 |
| Last Update Date | 2013-09-20 |
| Authorized Official Name | MR. BRIAN DAVID DIAZ (OWNER) |
| Authorized Official Telephone | 9194931204 |
| Authorized Official Credential | MPT |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2251X0800X |
Physical Therapist Specialization: Orthopedic |
8453 | NC | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Street Address |
4221 GARRETT RD SUITE 1-2 |
| City | DURHAM |
| State | NC |
| Zip Code | 27707-3467 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952468472 | Liberty Medical Specialties, Inc | Durable Medical Equipment & Medical Supplies | 4221 Garrett Rd, Unit # 10, Durham, NC 27707-3467 | 2007-01-03 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538785928 | Ceara Smith | Social Worker | 1415 W Nc 54 Buidling 200, Suite 111, Durham, NC 27707 | 2020-06-22 |
| 1114554094 | Lauren Michelle Grosse | Physician Assistant | Fastmed Urgent Care 7010 Nc-751, Durham, NC 27707 | 2020-03-23 |
| 1386289635 | Ashley Bailey | Counselor | 1801 Fayetteville Street, Durham, NC 27707 | 2019-11-11 |
| 1881249886 | Erin Ramona Leger | Physical Therapist | 3706 Mayfair St, Ste 120, Durham, NC 27707 | 2019-08-06 |
| 1417417262 | Carmen Elisabeth Sanchez | Psychologist | 3326 Durham Chapel Hill Blvd Bldg D, Durham, NC 27707 | 2019-03-20 |
| 1477026144 | Pope Behavioral Health and Wellness | Counselor | 5102 Chapel Hill Durham Blvd., Suite 101, Durham, NC 27707 | 2019-01-06 |
| 1043780778 | Jessica Ann Revels | Counselor | 1415 West North Carolina 54, Building 100 Suite # 204, Durham, NC 27707 | 2018-11-26 |
| 1558830125 | Michael Brown | Counselor | 1502 W Nc-54, Suite 505, Durham, NC 27707 | 2018-11-13 |
| 1780152827 | Cassandra Gerwig Shaw | Registered Nurse | 5324 Mcfarland Dr Ste 310, Durham, NC 27707 | 2018-11-07 |
| 1942776232 | Lisa J Keskitalo | Physical Therapist | 3708 Mayfair St Ste 120, Durham, NC 27707 | 2018-10-15 |
| Find all providers in zip 27707 | ||||
| Taxonomy Code | 2251X0800X |
| Grouping | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Classification | Physical Therapist |
| Specialization | Orthopedic |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679132690 | Demario Sharrod Lewis | Physical Therapist | 200 W Woodcroft Pkwy Apt 62b, Durham, NC 27713-8086 | 2019-06-12 |
| 1568979987 | Michael Alan Schmidt | Physical Therapist | Dumc 3965 Duke South Clinic 1b/1c, Durham, NC 27710-0001 | 2018-01-08 |
| 1568428340 | Spine Rehabilitation and Reeducation Center of North | Physical Therapist | 2309 Sparger Rd, Pob 2403, Durham, NC 27705-2227 | 2006-04-21 |
| 1831707066 | Kyle Brendan Stapleton | Physical Therapist | 2301 Erwin Rd, Durham, NC 27705-4699 | 2020-07-14 |
| 1750918470 | Jackson Davis | Physical Therapist | 508 Fulton St, Durham, NC 27705-3875 | 2020-03-24 |
| 1407334550 | Trevor Lentz | Physical Therapist | 2400 Pratt St, Durham, NC 27705-3976 | 2018-07-31 |
| 1750890802 | Monica Austin | Physical Therapist | 4709 Creekstone Dr Ste 300, Durham, NC 27703-0016 | 2017-09-20 |
| 1376070029 | Preston Roundy | Physical Therapist | 40 Duke Medicine Cir, Durham, NC 27710-4000 | 2017-05-12 |
| 1477080190 | Morven Ann Ross Malay | Physical Therapist | 501 Douglas St, Durham, NC 27705-3888 | 2017-05-11 |
| 1437399979 | Insideout Body Therapies, LLC | Physical Therapist | 5720 Fayetteville Rd, Suite 101, Durham, NC 27713-9089 | 2009-02-24 |
| Find all providers in DURHAM | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.