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General NPI Number Information
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NPI Number | 1467104307
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Entity Type | Organization
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Legal Business Name | AWARENESS PELVIC HEALTH
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Dates
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Enumeration Date | 01/21/2022
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Last Update Date | 01/21/2022
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Provider Practice Location Address
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Address Line | 1302 N SHEPHERD DR FL 3
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City | HOUSTON
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State | TX
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Zip | 77008-3752
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Country | US
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Telephone | 832-512-8722
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Fax |
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Provider Business Mailing Address
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Address Line | 5470 W BROADWAY ST. STE 116
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City | PEARLAND
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State | TX
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Zip | 77581
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Country | US
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Telephone | 832-512-8722
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Fax |
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | DR. MAMAWAH I BOURQUE
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Credential | DPT
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Telephone | 832-512-8722
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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