Healthcare Provider Details

I. General information

NPI: 1205859881
Provider Name (Legal Business Name): RODERICK SANFORD HENDERSON MPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 10/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14700 FM 2100 RD STE 4
CROSBY TX
77532-9162
US

IV. Provider business mailing address

14700 FM 2100 RD STE 4
CROSBY TX
77532-9162
US

V. Phone/Fax

Practice location:
  • Phone: 281-328-8346
  • Fax: 281-328-8347
Mailing address:
  • Phone: 281-328-8346
  • Fax: 281-328-8347

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1144798
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: