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General NPI Number Information
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NPI Number | 1417513193
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Entity Type | Organization
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Legal Business Name | ACTIVE LIFE HEALTH OF CINCINNATI LLC
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Dates
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Enumeration Date | 05/17/2019
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Last Update Date | 05/17/2019
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Provider Practice Location Address
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Address Line | 8251 PINE RD STE 205
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City | CINCINNATI
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State | OH
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Zip | 45236-2191
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Country | US
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Telephone | 513-904-5888
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Fax | 513-904-5867
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Provider Business Mailing Address
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Address Line | PO BOX 79662
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City | BALTIMORE
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State | MD
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Zip | 21279-0662
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Country | US
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Telephone | 513-904-5888
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Fax | 513-904-5867
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Authorized Official
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Title or Position | OWNER
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Name | JOHN RUSH
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Credential | MD
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Telephone | 301-928-1697
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State |
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