MEDICARE: SAVITHA BONTHALA D.O., M.P.H.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2081P0301X	Brain Injury Medicine (Physical Medicine & Rehabilitation) Physician	R8869	TX

General Provider Information

NPI Number	:	1033551965
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAVITHA BONTHALA D.O., M.P.H.

Provider Business Mailing Address
First Line	:	15403 BAY COVE CT
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77059-5821
Country	:	US
Telephone Number	:	281-382-4838
Fax Number	:

Provider Business Practice Location Address
First Line	:	1300 BINZ ST FL 3
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77004-7016
Country	:	US
Telephone Number	:	713-285-1000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/19/2013
Last Update Date	:	09/08/2020

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