Provider Demographics
NPI:1205859881
Name:HENDERSON, RODERICK SANFORD (MPT)
Entity Type:Individual
Prefix:MR
First Name:RODERICK
Middle Name:SANFORD
Last Name:HENDERSON
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14700 FM 2100 RD STE 4
Mailing Address - Street 2:
Mailing Address - City:CROSBY
Mailing Address - State:TX
Mailing Address - Zip Code:77532-9162
Mailing Address - Country:US
Mailing Address - Phone:281-328-8346
Mailing Address - Fax:281-328-8347
Practice Address - Street 1:14700 FM 2100 RD STE 4
Practice Address - Street 2:
Practice Address - City:CROSBY
Practice Address - State:TX
Practice Address - Zip Code:77532-9162
Practice Address - Country:US
Practice Address - Phone:281-328-8346
Practice Address - Fax:281-328-8347
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2008-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1144798225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX9539182OtherAETNA
TX8T3292OtherBLUE CROSS BLUE SHIELD
TX8E0114Medicare PIN