Healthcare Provider Details

I. General information

NPI: 1861842767
Provider Name (Legal Business Name): HOUSTON SPINE & REHABILITATION AFFILIATES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2016
Last Update Date: 06/05/2025
Certification Date: 06/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3101 COLLEGE PARK DR
THE WOODLANDS TX
77384-4099
US

IV. Provider business mailing address

3101 COLLEGE PARK DR
THE WOODLANDS TX
77384-4099
US

V. Phone/Fax

Practice location:
  • Phone: 281-362-0006
  • Fax: 281-362-0233
Mailing address:
  • Phone: 281-362-0006
  • Fax: 281-362-0233

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License NumberJ4247
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberJ4247
License Number StateTX

VIII. Authorized Official

Name: MS. REBECCA A SANDEFUR
Title or Position: CEO
Credential:
Phone: 281-362-0006