Provider Demographics
NPI:1477155182
Name:SHIH, HENRY EDISON
Entity Type:Individual
Prefix:
First Name:HENRY
Middle Name:EDISON
Last Name:SHIH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1927 ROUND LAKE DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77077-5907
Mailing Address - Country:US
Mailing Address - Phone:713-339-0689
Mailing Address - Fax:
Practice Address - Street 1:1413 MADISON PARK DR STE 100
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-6355
Practice Address - Country:US
Practice Address - Phone:443-583-3757
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-09
Last Update Date:2023-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1338458225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist