Healthcare Provider Details

I. General information

NPI: 1104590868
Provider Name (Legal Business Name): BINAL DHOLARIYA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2021
Last Update Date: 11/15/2022
Certification Date: 11/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11242 FM 1960 RD W STE 104
HOUSTON TX
77065-3635
US

IV. Provider business mailing address

11242 FM 1960 RD W STE 104
HOUSTON TX
77065-3635
US

V. Phone/Fax

Practice location:
  • Phone: 281-469-8163
  • Fax: 281-469-5559
Mailing address:
  • Phone: 281-469-8163
  • Fax: 281-469-5559

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1345124
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: