# ACTIVE LIFE HEALTH OF CINCINNATI LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1417513193
- **Authorized official:** JOHN RUSH MD (OWNER)
- **Authorized official phone:** (301) 928-1697

## Contact information

- **Practice address:** 8251 PINE RD STE 205, CINCINNATI, OH 45236-2191
- **Practice address phone:** (513) 904-5888
- **Practice address fax:** (513) 904-5867
- **Mailing address:** PO BOX 79662, BALTIMORE, MD 21279-0662
- **Mailing address phone:** (513) 904-5888
- **Mailing address fax:** (513) 904-5867

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | NULL | Yes |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | — | Yes |

## Other

- **Enumeration date:** 05/17/2019
- **Last updated:** 05/17/2019