MEDICARE: MANOLI BOLAR 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	1139178	TX

General Provider Information

NPI Number	:	1316066095
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MANOLI BOLAR PT

Provider Business Mailing Address
First Line	:	7300 BROMPTON ST APT 4624
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77025-2165
Country	:	US
Telephone Number	:	832-647-6796
Fax Number	:

Provider Business Practice Location Address
First Line	:	7300 BROMPTON ST APT 4624
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77025-2165
Country	:	US
Telephone Number	:	832-647-6796
Fax Number	:

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

Provider Enumeration Date	:	03/27/2007
Last Update Date	:	07/08/2007

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Directions to “ MANOLI BOLAR PT” Practice Location

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