MEDICARE: SAGE MEDICAL GROUP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	K3239	TX

General Provider Information

NPI Number	:	1700280450
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAGE MEDICAL GROUP

Provider Business Mailing Address
First Line	:	3388 SAGE RD UNIT P5
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77056-7238
Country	:	US
Telephone Number	:	361-652-0025
Fax Number	:

Provider Business Practice Location Address
First Line	:	3388 SAGE RD UNIT P5
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77056-7238
Country	:	US
Telephone Number	:	361-652-0025
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. PAUL HOANG
Credential	:	D.O.
Telephone Number	:	361-652-0025

Provider Enumeration Date	:	10/09/2014
Last Update Date	:	10/09/2014

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