MEDICARE: ROWELA B ISLAS 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	1049161	TX

General Provider Information

NPI Number	:	1346450277
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROWELA B ISLAS PT

Provider Business Mailing Address
First Line	:	2504 BERING DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77057-4902
Country	:	US
Telephone Number	:	713-789-8602
Fax Number	:

Provider Business Practice Location Address
First Line	:	2504 BERING DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77057-4902
Country	:	US
Telephone Number	:	713-789-8602
Fax Number	:

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

Provider Enumeration Date	:	05/22/2007
Last Update Date	:	07/08/2007

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