Organization
ACTIVE SPORTS PHYSICAL THERAPY PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MATTHEW SHANE PT, DPT (OWNER)
(254) 300-1941
Entity
Organization
Contact information
Practice address
331 W STATE HIGHWAY 6 STE G, WACO, TX 76710-5584
(254) 300-1941
(254) 875-0472
Mailing address
331 W STATE HIGHWAY 6 STE G, WACO, TX 76710-5584
(254) 300-1941
(254) 875-0472
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
—
—
Other
Enumeration date
03/05/2019
Last updated
07/05/2022
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