Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 1101491 | TX |
NPI | 1003029570 |
---|---|
Provider Name | Mr. Ruben Isidro Bautista |
First Address | Spring, TX 77379 |
Second Address | Houston, TX 77076 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/05/2007 |
Last Update Date | 08/07/2007 |