MEDICARE: MRS. BRANDI LEE CABIRO 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	1153746	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8T4238	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1518943232
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BRANDI LEE CABIRO P.T.

Provider Business Mailing Address
First Line	:	4219 RICHMOND AVE
Second Line	:	SUITE 110
City	:	HOUSTON
State	:	TX
Zip	:	77027-6893
Country	:	US
Telephone Number	:	713-621-2486
Fax Number	:	713-621-2491

Provider Business Practice Location Address
First Line	:	4219 RICHMOND AVE
Second Line	:	SUITE 110
City	:	HOUSTON
State	:	TX
Zip	:	77027-6893
Country	:	US
Telephone Number	:	713-621-2486
Fax Number	:	713-621-2491

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

Provider Enumeration Date	:	12/15/2005
Last Update Date	:	07/08/2007

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