Provider Demographics
NPI:1073355566
Name:ACTIVE LIFE HEALTH OF GREENSBORO PLLC
Entity type:Organization
Organization Name:ACTIVE LIFE HEALTH OF GREENSBORO PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
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 1:1414 YANCEYVILLE ST STE 200
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27405-6947
Mailing Address - Country:US
Mailing Address - Phone:336-895-1598
Mailing Address - Fax:336-390-2170
Practice Address - Street 1:1414 YANCEYVILLE ST STE 200
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27405-6947
Practice Address - Country:US
Practice Address - Phone:336-895-1598
Practice Address - Fax:336-390-2170
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-06
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty