MEDICARE: LAKSHMI DEEPTI URLAM 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	225200000X	Physical Therapy Assistant	2094661	TX
2	225100000X	Physical Therapist	1229435	TX

General Provider Information

NPI Number	:	1578806816
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAKSHMI DEEPTI URLAM PT

Provider Business Mailing Address
First Line	:	800 BONAVENTURE WAY STE 167
Second Line	:
City	:	SUGAR LAND
State	:	TX
Zip	:	77479-8007
Country	:	US
Telephone Number	:	832-559-2900
Fax Number	:	832-559-2900

Provider Business Practice Location Address
First Line	:	10401 S MASON RD UNIT E-505
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77406-5885
Country	:	US
Telephone Number	:	832-847-6130
Fax Number	:	832-847-6132

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

Provider Enumeration Date	:	04/05/2013
Last Update Date	:	01/24/2026

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