Provider Demographics
NPI:1619126356
Name:HOUSTON PRO MEDICAL GROUP
Entity Type:Organization
Organization Name:HOUSTON PRO MEDICAL GROUP
Other - Org Name:OLLIN ATHLETICS AND SPORTS MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF SPORTS MEDICINE
Authorized Official - Prefix:DR
Authorized Official - First Name:MINH
Authorized Official - Middle Name:THE
Authorized Official - Last Name:LUU
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:281-804-9096
Mailing Address - Street 1:12539 PERRY RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77070-5038
Mailing Address - Country:US
Mailing Address - Phone:281-499-7539
Mailing Address - Fax:281-499-7575
Practice Address - Street 1:12539 PERRY RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-5038
Practice Address - Country:US
Practice Address - Phone:832-810-0274
Practice Address - Fax:832-810-0276
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-18
Last Update Date:2015-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9027111NS0005X
TX11603782251S0007X
TX2056716225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSportsGroup - Multi-Specialty
No111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Multi-Specialty
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Multi-Specialty