Healthcare Provider Details

I. General information

NPI: 1245439819
Provider Name (Legal Business Name): SPORTS & SPINE ASSOCIATES, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2007
Last Update Date: 05/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7756 NORTHCROSS DR SUITE 203
AUSTIN TX
78757-1735
US

IV. Provider business mailing address

PO BOX 27165
AUSTIN TX
78755-2165
US

V. Phone/Fax

Practice location:
  • Phone: 512-358-0500
  • Fax: 512-358-0520
Mailing address:
  • Phone: 512-358-0500
  • Fax: 512-358-0520

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberH2890
License Number StateTX

VIII. Authorized Official

Name: DR. LORI BETH WASSERBURGER
Title or Position: PRESIDENT
Credential: M.D.
Phone: 512-358-0500