Healthcare Provider Details

I. General information

NPI: 1053722561
Provider Name (Legal Business Name): MTL HEALTH & PERFORMANCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2014
Last Update Date: 05/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20919 SUMMER TRACE LN
SPRING TX
77379-8470
US

IV. Provider business mailing address

20919 SUMMER TRACE LN
SPRING TX
77379-8470
US

V. Phone/Fax

Practice location:
  • Phone: 281-804-9096
  • Fax:
Mailing address:
  • Phone: 281-804-9096
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number9027
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number9027
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License Number9027
License Number StateTX

VIII. Authorized Official

Name: DR. MINH THE LUU
Title or Position: DIRECTOR
Credential: D.C.
Phone: 281-804-9096