MEDICARE: ANISH ABRAHAM (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	1150110	TX

General Provider Information

NPI Number	:	1700107257
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANISH ABRAHAM (P.T)

Provider Business Mailing Address
First Line	:	5771 ENID ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77009-1208
Country	:	US
Telephone Number	:	713-880-4400
Fax Number	:	713-869-8637

Provider Business Practice Location Address
First Line	:	9940 W SAM HOUSTON PKWY S STE 320
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77099-5104
Country	:	US
Telephone Number	:	832-300-2626
Fax Number	:	832-300-2625

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

Provider Enumeration Date	:	06/18/2010
Last Update Date	:	06/21/2010

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Directions to “ ANISH ABRAHAM (P.T)” Practice Location

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