Healthcare Provider Details

I. General information

NPI: 1124860143
Provider Name (Legal Business Name): CO-ACTIVE PHYSICAL THERAPY AND WELLNESS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2024
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 HARMONY HILL RD
GRAPEVINE TX
76051-1135
US

IV. Provider business mailing address

301 HARMONY HILL RD
GRAPEVINE TX
76051-1135
US

V. Phone/Fax

Practice location:
  • Phone: 770-241-4526
  • Fax:
Mailing address:
  • Phone: 770-241-4526
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: MEGHA SHAH
Title or Position: PHYSICAL THERAPIST
Credential:
Phone: 770-241-4526