Healthcare Provider Details

I. General information

NPI: 1457397424
Provider Name (Legal Business Name): PHYSIOTHERAPY SPORTS MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14700 FM 2100 RD SUITE 4
CROSBY TX
77532-9161
US

IV. Provider business mailing address

14700 FM 2100 RD SUITE 4
CROSBY TX
77532-9161
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 Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number StateTX

VIII. Authorized Official

Name: MR. RODERICK HENDERSON
Title or Position: FACILITY DIRECTOR
Credential: P.T.
Phone: 281-328-8346