MEDICARE: MR. CORNELIO SILVAS RAMIREZ JR. P.T.

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	1135465	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8T3653	OTHER	TX	BCBS ID#

General Provider Information

NPI Number	:	1477537082
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CORNELIO SILVAS RAMIREZ JR. P.T.

Provider Business Mailing Address
First Line	:	8955 HIGHWAY 6 N STE 190
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77095-2321
Country	:	US
Telephone Number	:	325-938-6008
Fax Number	:	832-593-8601

Provider Business Practice Location Address
First Line	:	12000 RICHMOND AVE
Second Line	:	SUITE 150
City	:	HOUSTON
State	:	TX
Zip	:	77082-2431
Country	:	US
Telephone Number	:	281-920-5100
Fax Number	:	281-920-5101

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

Provider Enumeration Date	:	12/06/2005
Last Update Date	:	08/20/2020

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