Provider Demographics
NPI:1417143405
Name:ACTIVE PLUS REHAB, INC.
Entity Type:Organization
Organization Name:ACTIVE PLUS REHAB, INC.
Other - Org Name:SPINAL DECOMPRESSION OF FORT WORTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAND
Authorized Official - Middle Name:H
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:817-560-8100
Mailing Address - Street 1:8808 CAMP BOWIE W
Mailing Address - Street 2:SUITE 150
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76116-6028
Mailing Address - Country:US
Mailing Address - Phone:817-560-8100
Mailing Address - Fax:817-560-8103
Practice Address - Street 1:8808 CAMP BOWIE W
Practice Address - Street 2:SUITE 150
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76116-6028
Practice Address - Country:US
Practice Address - Phone:817-560-8100
Practice Address - Fax:817-560-8103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-24
Last Update Date:2007-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF007684111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty