Provider Demographics
NPI:1861101776
Name:ANDERSON, ELDRIDGE III (PTA)
Entity type:Individual
Prefix:MR
First Name:ELDRIDGE
Middle Name:
Last Name:ANDERSON
Suffix:III
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9522 N SAM HOUSTON PKWY E STE 2330
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77396-4695
Mailing Address - Country:US
Mailing Address - Phone:713-814-2510
Mailing Address - Fax:713-704-3890
Practice Address - Street 1:9522 N SAM HOUSTON PKWY E STE 2330
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77396-4695
Practice Address - Country:US
Practice Address - Phone:713-814-2510
Practice Address - Fax:713-704-3890
Is Sole Proprietor?:No
Enumeration Date:2022-11-18
Last Update Date:2022-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX21506582081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine