MEDICARE: STARLIGHT PEDIATRIC THERAPY LLC

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	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1376363036
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STARLIGHT PEDIATRIC THERAPY LLC

Provider Business Mailing Address
First Line	:	5402 OBAN TERRACE LN
Second Line	:
City	:	SUGAR LAND
State	:	TX
Zip	:	77479-4776
Country	:	US
Telephone Number	:	248-980-5987
Fax Number	:

Provider Business Practice Location Address
First Line	:	5402 OBAN TERRACE LN
Second Line	:
City	:	SUGAR LAND
State	:	TX
Zip	:	77479-4776
Country	:	US
Telephone Number	:	248-980-5987
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. REEMA BILAL
Credential	:	PT, DPT
Telephone Number	:	248-980-5987

Provider Enumeration Date	:	10/16/2024
Last Update Date	:	10/16/2024

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