Provider Demographics
NPI:1407947146
Name:CENTER FOR SPINE SPORTS AND PHYSICAL MEDICINE P.A.
Entity Type:Organization
Organization Name:CENTER FOR SPINE SPORTS AND PHYSICAL MEDICINE P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAUN
Authorized Official - Middle Name:D
Authorized Official - Last Name:LEHMANN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-357-5454
Mailing Address - Street 1:PO BOX 1567
Mailing Address - Street 2:
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77377-1567
Mailing Address - Country:US
Mailing Address - Phone:281-357-5454
Mailing Address - Fax:281-357-5499
Practice Address - Street 1:25216 GROGANS PARK DR
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77380-2175
Practice Address - Country:US
Practice Address - Phone:281-357-5454
Practice Address - Fax:281-357-5499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2013-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK7182204C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX159109102Medicaid
TX159109102Medicaid