Healthcare Provider Details

I. General information

NPI: 1861829863
Provider Name (Legal Business Name): CENTER FOR SPINE, SPORTS AND REHABILITATION EXCELLENCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2013
Last Update Date: 01/29/2024
Certification Date: 01/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 HIGHWAY 6 SUITE 145
SUGAR LAND TX
77478-4914
US

IV. Provider business mailing address

1111 HIGHWAY 6 STE 145
SUGAR LAND TX
77478-4960
US

V. Phone/Fax

Practice location:
  • Phone: 713-590-2700
  • Fax: 713-590-2702
Mailing address:
  • Phone: 713-590-2700
  • Fax: 713-590-2702

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. BENOY V BENNY
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 713-590-2700