MEDICARE: PINE HOLLOW HOLDINGS CORP

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	208100000X	Physical Medicine & Rehabilitation Physician

General Provider Information

NPI Number	:	1740136332
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PINE HOLLOW HOLDINGS CORP

Provider Business Mailing Address
First Line	:	8525 N SAM HOUSTON PKWY E BLDG 400
Second Line	:	SUITE 401
City	:	HUMBLE
State	:	TX
Zip	:	77396-5228
Country	:	US
Telephone Number	:	832-412-2033
Fax Number	:	832-995-0554

Provider Business Practice Location Address
First Line	:	8525 N SAM HOUSTON PKWY E BLDG 400
Second Line	:
City	:	HUMBLE
State	:	TX
Zip	:	77396-5228
Country	:	US
Telephone Number	:	832-412-2033
Fax Number	:	832-995-0554

Authorized Official
Title or Position	:	OWNER
Name	:	SEAN UPCHURCH
Credential	:
Telephone Number	:	832-412-2033

Provider Enumeration Date	:	03/06/2026
Last Update Date	:	03/06/2026

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Directions to “PINE HOLLOW HOLDINGS CORP ” Practice Location

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