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General NPI Number Information
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NPI Number | 1831561208
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Entity Type | Organization
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Legal Business Name | PRO-ACTIVE NEUROLOGY & SPORTS REHAB
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Dates
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Enumeration Date | 10/26/2015
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Last Update Date | 10/26/2015
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Provider Practice Location Address
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Address Line | 7355 BARLITE BLVD STE 101
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City | SAN ANTONIO
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State | TX
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Zip | 78224-1340
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Country | US
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Telephone | 210-333-1477
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Fax | 210-558-0520
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Provider Business Mailing Address
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Address Line | 7355 BARLITE BLVD STE 101
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City | SAN ANTONIO
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State | TX
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Zip | 78224-1340
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Country | US
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Telephone | 210-333-1477
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Fax | 210-558-0520
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Authorized Official
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Title or Position | OWNER
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Name | ROBERT C LOWRY
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Credential | M.D.
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Telephone | 210-333-1477
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number | J9179
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License Number State | TX
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