Healthcare Provider Details

I. General information

NPI: 1578032728
Provider Name (Legal Business Name): ARLI JOHN BOLORON PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2018
Last Update Date: 11/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11777 FM 1960 RD W
HOUSTON TX
77065-3513
US

IV. Provider business mailing address

11777 FM 1960 RD W
HOUSTON TX
77065-3513
US

V. Phone/Fax

Practice location:
  • Phone: 281-469-4688
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number1310306
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: