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General NPI Number Information
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NPI Number | 1760440069
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Entity Type | Organization
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Legal Business Name | ACTIVE LIFESTYLE PRODUCTS
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Dates
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Enumeration Date | 05/03/2006
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Last Update Date | 06/16/2008
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Provider Practice Location Address
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Address Line | 1 SPYGLASS CT
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City | HOUSTON
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State | TX
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Zip | 77064-4060
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Country | US
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Telephone | 832-746-7370
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Fax | 281-897-0500
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Provider Business Mailing Address
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Address Line | 10910 KATY FWY
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City | HOUSTON
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State | TX
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Zip | 77079-2204
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Country | US
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Telephone | 281-897-0500
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Fax | 281-897-0500
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. IOANNIS XIDERIS
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Credential |
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Telephone | 281-897-0500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 0081833
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License Number State | TX
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