MEDICARE: RAJASHEKHER BOLLA PT

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	225100000X	Physical Therapist	1180068	TX
2	225100000X	Physical Therapist	016541	NY

General Provider Information

NPI Number	:	1265764864
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAJASHEKHER BOLLA PT

Provider Business Mailing Address
First Line	:	PO BOX 2528
Second Line	:
City	:	SUGAR LAND
State	:	TX
Zip	:	77487-2528
Country	:	US
Telephone Number	:	234-567-9194
Fax Number	:

Provider Business Practice Location Address
First Line	:	1020 HOLCOMBE BLVD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-2210
Country	:	US
Telephone Number	:	713-792-2295
Fax Number	:

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

Provider Enumeration Date	:	02/05/2010
Last Update Date	:	02/05/2010

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Directions to “ RAJASHEKHER BOLLA PT” Practice Location

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