Provider Demographics
NPI:1275895807
Name:CYPRESS PRO MEDICAL GROUP
Entity Type:Organization
Organization Name:CYPRESS PRO MEDICAL GROUP
Other - Org Name:OLLIN CYPRESS ATHLETICS AND SPORTS MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MINH
Authorized Official - Middle Name:THE
Authorized Official - Last Name:LUU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-804-9096
Mailing Address - Street 1:16518 HOUSE HAHL RD STE F5
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77433-1901
Mailing Address - Country:US
Mailing Address - Phone:281-804-9096
Mailing Address - Fax:
Practice Address - Street 1:16518 HOUSE HAHL RD
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77433-1901
Practice Address - Country:US
Practice Address - Phone:281-804-9096
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-11
Last Update Date:2015-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9027111NR0400X
TX11603782251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Multi-Specialty
No111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty