MEDICARE: LAKSHMIBA LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	225100000X	Physical Therapist
2	2255A2300X	Athletic Trainer
3	261QR0401X	Comprehensive Outpatient Rehabilitation Facility (CORF)

General Provider Information

NPI Number	:	1679169247
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAKSHMIBA LLC

Provider Business Mailing Address
First Line	:	2900 WESLAYAN ST STE 545
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77027-5369
Country	:	US
Telephone Number	:	281-940-9423
Fax Number	:	713-969-4834

Provider Business Practice Location Address
First Line	:	1010 TRAVIS ST STE 800
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77002-5928
Country	:	US
Telephone Number	:	281-940-9423
Fax Number	:	713-969-4834

Authorized Official
Title or Position	:	MANAGER
Name	:	SHASHI M PATIL
Credential	:
Telephone Number	:	832-212-7767

Provider Enumeration Date	:	12/17/2020
Last Update Date	:	03/17/2021

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Directions to “LAKSHMIBA LLC ” Practice Location

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