MEDICARE: HOUSTON PRO MEDICAL GROUP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111NS0005X	Sports Physician Chiropractor	9027	TX
2	225200000X	Physical Therapy Assistant	2056716	TX
3	2251S0007X	Sports Physical Therapist	1160378	TX

General Provider Information

NPI Number	:	1619126356
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOUSTON PRO MEDICAL GROUP

Provider Business Mailing Address
First Line	:	12539 PERRY RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77070-5038
Country	:	US
Telephone Number	:	281-499-7539
Fax Number	:	281-499-7575

Provider Business Practice Location Address
First Line	:	12539 PERRY RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77070-5038
Country	:	US
Telephone Number	:	832-810-0274
Fax Number	:	832-810-0276

Authorized Official
Title or Position	:	DIRECTOR OF SPORTS MEDICINE
Name	:	DR. MINH THE LUU
Credential	:	D.C.
Telephone Number	:	281-804-9096

Provider Enumeration Date	:	09/18/2008
Last Update Date	:	10/21/2015

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Directions to “HOUSTON PRO MEDICAL GROUP ” Practice Location

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