Provider Demographics
NPI:1477638328
Name:SAGINAW VALLEY SPORT & SPINE LIMITED PARTNERSHIP
Entity Type:Organization
Organization Name:SAGINAW VALLEY SPORT & SPINE LIMITED PARTNERSHIP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP/AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:JANNA
Authorized Official - Middle Name:P
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:JD/
Authorized Official - Phone:713-297-7000
Mailing Address - Street 1:1300 W SAM HOUSTON PKWY S
Mailing Address - Street 2:SUITE 300
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77042-2447
Mailing Address - Country:US
Mailing Address - Phone:713-297-7000
Mailing Address - Fax:713-297-7090
Practice Address - Street 1:7680 GRATIOT RD
Practice Address - Street 2:UNITS 4 & 5
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48609-5036
Practice Address - Country:US
Practice Address - Phone:989-781-1258
Practice Address - Fax:989-781-1419
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SAGINAW VALLEY SPORT & SPINE LIMITED PARTNERSHIP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-26
Last Update Date:2009-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI236632Medicare Oscar/Certification