Provider Demographics
NPI:1902072754
Name:PRO-ACTIVE LIFE TREATMENT CENTER
Entity Type:Organization
Organization Name:PRO-ACTIVE LIFE TREATMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GERHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:MAALE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-696-7200
Mailing Address - Street 1:8230 WALNUT HILL LN
Mailing Address - Street 2:SUITE 514
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-4482
Mailing Address - Country:US
Mailing Address - Phone:214-696-7200
Mailing Address - Fax:214-691-1123
Practice Address - Street 1:8230 WALNUT HILL LN
Practice Address - Street 2:SUITE 514
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-4482
Practice Address - Country:US
Practice Address - Phone:214-696-7200
Practice Address - Fax:214-691-1123
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-01
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain