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General NPI Number Information
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NPI Number | 1629086731
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Entity Type | Organization
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Legal Business Name | ACTIVE REHABILITATION,INC.
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Dates
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Enumeration Date | 08/04/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1200 COIT RD SUITE 101A
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City | PLANO
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State | TX
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Zip | 75075-4750
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Country | US
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Telephone | 972-964-6633
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 261441
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City | PLANO
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State | TX
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Zip | 75026-1441
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Country | US
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Telephone | 972-964-6633
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. SCOTT CALDWELL
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Credential | MED.
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Telephone | 972-964-6633
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State | TX
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