Individual
BANNECKER BAXTER WOODS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
21301 KUYKENDAHL RD STE B, SPRING, TX 77379-2614
(281) 379-2102
(281) 379-1760
Mailing address
21301 KUYKENDAHL RD STE B, SPRING, TX 77379-2614
(281) 379-2102
(281) 379-1760
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
1329453
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1329453
STATE LICENSE
TX
Enumeration date
04/02/2020
Last updated
05/12/2020
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