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General NPI Number Information
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NPI Number | 1710572359
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Entity Type | Organization
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Legal Business Name | ACTIVE LIFE HEALTH OF PINEVILLE PLLC
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Dates
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Enumeration Date | 03/05/2021
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Last Update Date | 03/05/2021
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Provider Practice Location Address
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Address Line | 10035 PARK CEDAR DR STE 300
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City | CHARLOTTE
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State | NC
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Zip | 28210-8910
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Country | US
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Telephone | 704-272-3828
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Fax | 704-886-1884
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Provider Business Mailing Address
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Address Line | 10035 PARK CEDAR DR STE 300
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City | CHARLOTTE
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State | NC
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Zip | 28210-8910
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Country | US
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Telephone | 704-272-3828
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Fax | 704-886-1884
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Authorized Official
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Title or Position | CHAIRMAN & CHIEF EXECUTIVE OFFICER
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Name | JOHN J RUSH
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Credential | MD
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Telephone | 704-272-3828
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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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