MEDICARE: MR. FILEMON BAUTISTA PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	1058535	TX

General Provider Information

NPI Number	:	1174790281
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. FILEMON BAUTISTA PT

Provider Business Mailing Address
First Line	:	1601 MAIN ST
Second Line	:	SUITE 602
City	:	RICHMOND
State	:	TX
Zip	:	77469-3247
Country	:	US
Telephone Number	:	281-341-2874
Fax Number	:	281-341-3012

Provider Business Practice Location Address
First Line	:	7731 SOUTHWEST FWY
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77074-1815
Country	:	US
Telephone Number	:	713-456-5221
Fax Number	:	713-456-5229

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/08/2008
Last Update Date	:	05/08/2008

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