Provider Demographics
NPI:1396537916
Name:ACTIVE LIFE HEALTH OF WEBSTER PLLC
Entity type:Organization
Organization Name:ACTIVE LIFE HEALTH OF WEBSTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OF THE ENTITY
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:J
Authorized Official - Last Name:RUSH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-928-1697
Mailing Address - Street 1:251 W MEDICAL CENTER BLVD STE 230
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-4242
Mailing Address - Country:US
Mailing Address - Phone:281-603-9200
Mailing Address - Fax:281-205-3502
Practice Address - Street 1:251 W MEDICAL CENTER BLVD STE 230
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-4242
Practice Address - Country:US
Practice Address - Phone:281-603-9200
Practice Address - Fax:281-205-3502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-20
Last Update Date:2025-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty