MEDICARE: DELNAZ KHOSRAVIAN

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

General Provider Information

NPI Number	:	1235874132
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DELNAZ KHOSRAVIAN

Provider Business Mailing Address
First Line	:	1531 DOROTHY ST UNIT A
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77008-3587
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1531 DOROTHY ST UNIT A
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77008-3587
Country	:	US
Telephone Number	:	832-746-5170
Fax Number	:

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

Provider Enumeration Date	:	05/04/2022
Last Update Date	:	05/04/2022

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