Provider Demographics
NPI:1154910800
Name:SUGARLAND SPORTS MEDICINE AND INJURY CLINIC LLC
Entity type:Organization
Organization Name:SUGARLAND SPORTS MEDICINE AND INJURY CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MAZEN
Authorized Official - Middle Name:
Authorized Official - Last Name:ZAIBAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:346-342-1818
Mailing Address - Street 1:2655 CORDES DR STE 130
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-1461
Mailing Address - Country:US
Mailing Address - Phone:832-271-7542
Mailing Address - Fax:832-412-2957
Practice Address - Street 1:2655 CORDES DR STE 130
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-1461
Practice Address - Country:US
Practice Address - Phone:832-271-7542
Practice Address - Fax:832-412-2957
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-15
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty