| Active Health Physical Medicine, Pllc | |
|
6431 Southwest Blvd Benbrook TX 76132-2777 | |
| (817) 738-9777 | |
| Not Available |
| Full Name | Active Health Physical Medicine, Pllc |
|---|---|
| Speciality | General Practice |
| Location | 6431 Southwest Blvd, Benbrook, Texas |
| Authorized Official Name and Position | Elias Lara (SOLE MBR) |
| Authorized Official Contact | 8177389777 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Active Health Physical Medicine, Pllc 6431 Southwest Blvd Benbrook TX 76132-2777 Ph: (817) 738-9777 | Active Health Physical Medicine, Pllc 6431 Southwest Blvd Benbrook TX 76132-2777 Ph: (817) 738-9777 |
| NPI Number | 1386003259 |
|---|---|
| Provider Enumeration Date | 02/19/2016 |
| Last Update Date | 02/19/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1386003259 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (Texas) | Primary |
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