Provider Demographics
NPI:1780626150
Name:MEDICAL AND SPORTS THERAPY
Entity type:Organization
Organization Name:MEDICAL AND SPORTS THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:SUNDRA
Authorized Official - Middle Name:R
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-731-6261
Mailing Address - Street 1:2800 ANTOINE DR
Mailing Address - Street 2:2884-D
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77092-7042
Mailing Address - Country:US
Mailing Address - Phone:832-731-6261
Mailing Address - Fax:281-820-6233
Practice Address - Street 1:2800 ANTOINE DR
Practice Address - Street 2:2864-D
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77092-7042
Practice Address - Country:US
Practice Address - Phone:832-731-6261
Practice Address - Fax:281-820-6233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies