MEDICARE: RODERICK JOSEPH PTA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	2068341	TX

General Provider Information

NPI Number	:	1265183438
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RODERICK JOSEPH PTA

Provider Business Mailing Address
First Line	:	PO BOX 14836
Second Line	:
City	:	HUMBLE
State	:	TX
Zip	:	77347-4836
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	18839 MCKAY DR
Second Line	:
City	:	HUMBLE
State	:	TX
Zip	:	77338-5721
Country	:	US
Telephone Number	:	281-446-3655
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/10/2022
Last Update Date	:	01/10/2022

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Directions to “ RODERICK JOSEPH PTA” Practice Location

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