Provider Demographics
NPI:1831559905
Name:SPINE AND SPORTS PHYSICAL THERAPY
Entity type:Organization
Organization Name:SPINE AND SPORTS PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GREG
Authorized Official - Middle Name:
Authorized Official - Last Name:HOUSE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:512-569-7309
Mailing Address - Street 1:1737 WESTEND PL
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-2252
Mailing Address - Country:US
Mailing Address - Phone:512-569-7309
Mailing Address - Fax:512-533-0003
Practice Address - Street 1:1737 WESTEND PL
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-2252
Practice Address - Country:US
Practice Address - Phone:512-569-7309
Practice Address - Fax:512-533-0003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-02
Last Update Date:2016-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty