MEDICARE: CENTER FOR SPINE, SPORTS AND REHABILITATION EXCELLENCE PA

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	208100000X	Physical Medicine & Rehabilitation Physician		TX

General Provider Information

NPI Number	:	1720228299
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTER FOR SPINE, SPORTS AND REHABILITATION EXCELLENCE PA

Provider Business Mailing Address
First Line	:	2100 WEST LOOP S
Second Line	:	SUITE 150
City	:	HOUSTON
State	:	TX
Zip	:	77027-3515
Country	:	US
Telephone Number	:	713-590-2700
Fax Number	:	713-590-2702

Provider Business Practice Location Address
First Line	:	2100 WEST LOOP S
Second Line	:	SUITE 150
City	:	HOUSTON
State	:	TX
Zip	:	77027-3515
Country	:	US
Telephone Number	:	713-590-2700
Fax Number	:	713-590-2702

Authorized Official
Title or Position	:	OWNER
Name	:	DR. BENOY BENNY
Credential	:	M.D.
Telephone Number	:	713-590-2700

Provider Enumeration Date	:	02/24/2009
Last Update Date	:	10/28/2015

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Directions to “CENTER FOR SPINE, SPORTS AND REHABILITATION EXCELLENCE PA ” Practice Location

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