Provider Demographics
NPI:1609298579
Name:WILLIAMS, RODERICK SHAUN (LAT)
Entity Type:Individual
Prefix:
First Name:RODERICK
Middle Name:SHAUN
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19100 NORTHPOINTE RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77377-5889
Mailing Address - Country:US
Mailing Address - Phone:281-352-3230
Mailing Address - Fax:
Practice Address - Street 1:19100 NORTHPOINTE RIDGE LN
Practice Address - Street 2:
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77377-5889
Practice Address - Country:US
Practice Address - Phone:281-352-3230
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-13
Last Update Date:2014-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT49552255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer