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General NPI Number Information
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NPI Number | 1023967247
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Entity Type | Individual
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Provider Name | ETHANLOUIE CABRILLOS BANDALES PT, DPT
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Gender | Male
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Dates
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Enumeration Date | 01/22/2026
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Last Update Date | 01/22/2026
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Provider Practice Location Address
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Address Line | 450 PARK GROVE DR
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City | KATY
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State | TX
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Zip | 77450-1571
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Country | US
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Telephone | 281-435-5732
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Fax |
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Provider Business Mailing Address
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Address Line | 7726 DREAM ROSE TRL
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City | KATY
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State | TX
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Zip | 77493-5620
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Country | US
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Telephone | 973-767-9875
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 1407443
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License Number State | TX
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