MEDICARE: PHYSIOTHERAPY SPORTS MEDICINE

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	261QP2000X	Physical Therapy Clinic/Center		TX

General Provider Information

NPI Number	:	1457397424
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHYSIOTHERAPY SPORTS MEDICINE

Provider Business Mailing Address
First Line	:	14700 FM 2100 RD
Second Line	:	SUITE 4
City	:	CROSBY
State	:	TX
Zip	:	77532-9161
Country	:	US
Telephone Number	:	281-328-8346
Fax Number	:	281-328-8347

Provider Business Practice Location Address
First Line	:	14700 FM 2100 RD
Second Line	:	SUITE 4
City	:	CROSBY
State	:	TX
Zip	:	77532-9161
Country	:	US
Telephone Number	:	281-328-8346
Fax Number	:	281-328-8347

Authorized Official
Title or Position	:	FACILITY DIRECTOR
Name	:	MR. RODERICK HENDERSON
Credential	:	P.T.
Telephone Number	:	281-328-8346

Provider Enumeration Date	:	06/20/2006
Last Update Date	:	08/22/2020

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Directions to “PHYSIOTHERAPY SPORTS MEDICINE ” Practice Location

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