=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558311365
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MUSTAFA H SAKERWALLA PT,OCS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/11/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13611 SKINNER RD SUITE 160
-----------------------------------------------------
City | CYPRESS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77429-1771
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-758-2727
-----------------------------------------------------
Fax | 281-758-2929
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 17151 MOUNTAIN CREST DR
-----------------------------------------------------
City | SPRING
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77379-2311
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-655-8305
-----------------------------------------------------
Fax | 281-655-8305
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2251X0800X
-----------------------------------------------------
Taxonomy Name | Orthopedic Physical Therapist
-----------------------------------------------------
License Number | 1116341
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------