Healthcare Provider Details

I. General information

NPI: 1902194889
Provider Name (Legal Business Name): ACTIVSTYLE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2011
Last Update Date: 10/31/2025
Certification Date: 10/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2615 E END BLVD S SUITE 235
MARSHALL TX
75672-7425
US

IV. Provider business mailing address

1055 WESTGATE DR STE 100
SAINT PAUL MN
55114-1451
US

V. Phone/Fax

Practice location:
  • Phone: 903-923-7010
  • Fax: 903-923-7011
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: DARRELL DOUGLAS RAWLINGS
Title or Position: CEO
Credential:
Phone: 612-895-7815