Provider Demographics
NPI:1679007975
Name:ACTIV REHAB AND WELLNESS
Entity Type:Organization
Organization Name:ACTIV REHAB AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:LE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:832-263-3210
Mailing Address - Street 1:3773 RICHMOND AVE
Mailing Address - Street 2:SUITE 540
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77046-3703
Mailing Address - Country:US
Mailing Address - Phone:832-263-3210
Mailing Address - Fax:844-965-9064
Practice Address - Street 1:3773 RICHMOND AVE
Practice Address - Street 2:SUITE 540
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77046-3703
Practice Address - Country:US
Practice Address - Phone:832-263-3210
Practice Address - Fax:844-965-9064
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-13
Last Update Date:2017-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12269111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty