Healthcare Provider Details

I. General information

NPI: 1316260979
Provider Name (Legal Business Name): CENTER FOR SPINE, SPORTS, AND REHABILITATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2010
Last Update Date: 03/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 WEST LOOP S
HOUSTON TX
77027-3515
US

IV. Provider business mailing address

2100 WEST LOOP S
HOUSTON TX
77027-3515
US

V. Phone/Fax

Practice location:
  • Phone: 713-798-4495
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P0004X
TaxonomySpinal Cord Injury Medicine Physician
License NumberM3907
License Number StateTX

VIII. Authorized Official

Name: BENOY BENNY
Title or Position: OWNER
Credential: MD
Phone: 713-798-4495