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Provider Information for 1316512551

Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know

ACTIVE LIFE HEALTH OF CHARLOTTE PLLC

Other Name:   Doing Business As: ARTHRITIS KNEE PAIN CENTERS
Organization Subpart: NO

Organization NPI: 1316512551

Calendar   Last Updated:  2021-05-20
  Certification Date:  2021-05-20

Details

Name Value
NPI 1316512551
Enumeration Date 2021-05-20
NPI Type 2- Organization
Status Active
Authorized Official Information Name: JOHN J RUSH MD
Title: CHAIRMAN & CHIEF EXECUTIVE OFFICER
Phone: 704-272-3884
Mailing Address 8401 MEDICAL PLAZA DR STE 355
CHARLOTTE, NC 28262-9718
United States

Phone: 704-272-3884 | Fax: 704-235-1629
View Map External Link
Primary Practice Address 8401 MEDICAL PLAZA DR STE 355
CHARLOTTE, NC 28262-9718
United States

Phone: 704-272-3884 | Fax: 704-235-1629
View Map External Link
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
Taxonomy
Primary Taxonomy Selected Taxonomy State License Number
Yes 193200000X MULTI-SPECIALTY GROUP
208100000X - Physical Medicine & Rehabilitation