MEDICARE: VIJETH BEKAL P.T.

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	1158063	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1158063	OTHER	TX	LICENSE NUMBER

General Provider Information

NPI Number	:	1407962657
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VIJETH BEKAL P.T.

Provider Business Mailing Address
First Line	:	2255 BRAESWOOD PARK DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-4454
Country	:	US
Telephone Number	:	713-884-0547
Fax Number	:

Provider Business Practice Location Address
First Line	:	3800 SPENCER HWY
Second Line	:	STE F
City	:	PASADENA
State	:	TX
Zip	:	77504-1251
Country	:	US
Telephone Number	:	713-943-8573
Fax Number	:

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

Provider Enumeration Date	:	08/21/2006
Last Update Date	:	07/08/2007

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