Healthcare Provider Details

I. General information

NPI: 1417143405
Provider Name (Legal Business Name): ACTIVE PLUS REHAB, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2007
Last Update Date: 09/24/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8808 CAMP BOWIE W SUITE 150
FORT WORTH TX
76116-6028
US

IV. Provider business mailing address

8808 CAMP BOWIE W SUITE 150
FORT WORTH TX
76116-6028
US

V. Phone/Fax

Practice location:
  • Phone: 817-560-8100
  • Fax: 817-560-8103
Mailing address:
  • Phone: 817-560-8100
  • Fax: 817-560-8103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License NumberF007684
License Number StateTX

VIII. Authorized Official

Name: DR. RAND H LEWIS
Title or Position: PRESIDENT
Credential: D.C.
Phone: 817-560-8100