Active Life Spine & Joint Clinic LLC

NPI #1083187553 in Rockford, Illinois

Provider Information

NPI Number: 1083187553
Entity Type: Organization
Organization Name: Active Life Spine & Joint Clinic LLC
Primary Specialty: Physical Therapist
Enumeration Date: Jan 8, 2019
Last Updated: Jan 8, 2019

Practice Location

Address: 3600 E STATE ST STE 222
City: Rockford
State: Illinois
ZIP Code: 61108-1956
Phone: (224) 425-0548

Authorized Official

Name: RONALD SAMANIEGO, PT
Title: OWNER
Phone: (224) 425-0548

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Physical Therapist	225100000X	Primary

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