Provider Demographics
NPI:1710516703
Name:WOODS, BANNECKER BAXTER
Entity Type:Individual
Prefix:
First Name:BANNECKER
Middle Name:BAXTER
Last Name:WOODS
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 1:21301 KUYKENDAHL RD STE B
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77379-2614
Mailing Address - Country:US
Mailing Address - Phone:281-379-2102
Mailing Address - Fax:281-379-1760
Practice Address - Street 1:21301 KUYKENDAHL RD STE B
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77379-2614
Practice Address - Country:US
Practice Address - Phone:281-379-2102
Practice Address - Fax:281-379-1760
Is Sole Proprietor?:No
Enumeration Date:2020-04-02
Last Update Date:2020-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1329453225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1329453OtherSTATE LICENSE