Provider Demographics
NPI:1588130967
Name:HAYDON, SAMUEL JAMES II (PTA)
Entity type:Individual
Prefix:MR
First Name:SAMUEL
Middle Name:JAMES
Last Name:HAYDON
Suffix:II
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 1:2115 WHITE FEATHER TRL
Mailing Address - Street 2:
Mailing Address - City:CROSBY
Mailing Address - State:TX
Mailing Address - Zip Code:77532-3274
Mailing Address - Country:US
Mailing Address - Phone:832-659-5775
Mailing Address - Fax:
Practice Address - Street 1:17231 MILL FOREST RD
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-4308
Practice Address - Country:US
Practice Address - Phone:281-488-5224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-23
Last Update Date:2018-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2138986225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant