Provider Demographics
NPI:1912714148
Name:ACTIVE RX LLC
Entity type:Organization
Organization Name:ACTIVE RX LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:LONGORIA
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT, FAAOMPT
Authorized Official - Phone:512-387-1539
Mailing Address - Street 1:12700 LOWDEN LN UNIT 4
Mailing Address - Street 2:
Mailing Address - City:MANCHACA
Mailing Address - State:TX
Mailing Address - Zip Code:78652-3605
Mailing Address - Country:US
Mailing Address - Phone:512-387-1539
Mailing Address - Fax:
Practice Address - Street 1:12700 LOWDEN LN UNIT 4
Practice Address - Street 2:
Practice Address - City:MANCHACA
Practice Address - State:TX
Practice Address - Zip Code:78652-3605
Practice Address - Country:US
Practice Address - Phone:512-387-1539
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-11
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty