Organization
ACTIVE HEALTH PHYSICAL MEDICINE, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ELIAS LARA DO (SOLE MBR)
(817) 738-9777
Entity
Organization
Contact information
Practice address
6431 SOUTHWEST BLVD, BENBROOK, TX 76132-2777
(817) 738-9777
Mailing address
6431 SOUTHWEST BLVD, BENBROOK, TX 76132-2777
(817) 738-9777
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
—
TX
Other
Enumeration date
02/19/2016
Last updated
02/19/2016
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