Individual
SAMUEL BENJAMIN ROTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LAT, ATC
Contact information
Practice address
17520 W GRAND PKWY S STE 100, SUGAR LAND, TX 77479-4759
(281) 725-5895
Mailing address
3505 W SAM HOUSTON PKWY S APT 5404, HOUSTON, TX 77042-2151
(402) 469-1006
Taxonomy
Speciality
Code
Description
License number
State
2251S0007X
Sports Physical Therapist
Primary
1357064
TX
2251X0800X
Orthopedic Physical Therapist
1357064
TX
2255A2300X
Athletic Trainer
AT8549
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
AT8549
AT LICENSE
TX
Enumeration date
12/28/2021
Last updated
08/18/2022
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