Provider Demographics
NPI:1912458266
Name:AHR MEDICAL GROUP, PA
Entity Type:Organization
Organization Name:AHR MEDICAL GROUP, PA
Other - Org Name:NEXTGEN WELLNESS CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GRANT
Authorized Official - Middle Name:
Authorized Official - Last Name:STOPHLET
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:972-382-9992
Mailing Address - Street 1:4101 CENTURION WAY
Mailing Address - Street 2:
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-4347
Mailing Address - Country:US
Mailing Address - Phone:972-382-9992
Mailing Address - Fax:
Practice Address - Street 1:4101 CENTURION WAY
Practice Address - Street 2:
Practice Address - City:ADDISON
Practice Address - State:TX
Practice Address - Zip Code:75001-4347
Practice Address - Country:US
Practice Address - Phone:972-382-9992
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-21
Last Update Date:2016-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1265208302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization