Healthcare Provider Details

I. General information

NPI: 1629219340
Provider Name (Legal Business Name): PAUL PUA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/09/2009
Last Update Date: 03/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4211 DRAKE ST UNIT C
HOUSTON TX
77005-1000
US

IV. Provider business mailing address

4211 DRAKE ST UNIT C
HOUSTON TX
77005-1000
US

V. Phone/Fax

Practice location:
  • Phone: 832-282-5719
  • Fax:
Mailing address:
  • Phone: 832-282-5719
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number171025
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: