Healthcare Provider Details

I. General information

NPI: 1093281305
Provider Name (Legal Business Name): SADRICK TERRELL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2018
Last Update Date: 10/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23107 BIRNAM WOOD BLVD
SPRING TX
77373-6807
US

IV. Provider business mailing address

23107 BIRNAM WOOD BLVD
SPRING TX
77373-6807
US

V. Phone/Fax

Practice location:
  • Phone: 281-687-0787
  • Fax:
Mailing address:
  • Phone: 281-687-0787
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number11037567
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: