| NPI | 1235418666 |
|---|---|
| Doing Business As | ACTIVE SPORTS THERAPY AND REHABILITATION |
| Entity Type | Organization |
| Authorized Contact | SETH ANDREW WAGENBLAST Owner 512-507-6681 |
| Organization Subpart ? | No |
| Primary Taxonomy | 111NS0005X Chiropractor, Sports Physician (Licence: TX 9995) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX 9995) |
| 111NR0400X Chiropractor, Rehabilitation (Licence: TX 9995) | |
| Enumeration Date | 2011-08-16 |
| Last Update Date | 2011-08-16 |