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General NPI Number Information
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NPI Number | 1497759211
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Entity Type | Organization
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Legal Business Name | THE WOODLANDS SPORTS MEDICINE CENTRE, PA
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Dates
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Enumeration Date | 06/09/2005
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Last Update Date | 02/12/2020
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Provider Practice Location Address
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Address Line | 1441 WOODSTEAD CT STE 300
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City | THE WOODLANDS
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State | TX
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Zip | 77380-1449
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Country | US
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Telephone | 281-367-0400
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Fax | 281-367-1201
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Provider Business Mailing Address
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Address Line | 1441 WOODSTEAD CT STE 300
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City | THE WOODLANDS
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State | TX
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Zip | 77380-1449
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Country | US
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Telephone | 281-367-0400
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Fax | 281-367-1201
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | CHRISTINE R GLADDEN IV
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Credential | LVN
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Telephone | 281-367-0400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State | TX
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