MEDICARE: NICOLE MARIE BARDAJI

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	1306695	TX

General Provider Information

NPI Number	:	1982239448
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE MARIE BARDAJI

Provider Business Mailing Address
First Line	:	5403 WINLOCK TRACE CT
Second Line	:
City	:	KATY
State	:	TX
Zip	:	77450-7228
Country	:	US
Telephone Number	:	832-213-6767
Fax Number	:

Provider Business Practice Location Address
First Line	:	10125 KATY FWY
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77024-1286
Country	:	US
Telephone Number	:	713-984-6720
Fax Number	:

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

Provider Enumeration Date	:	03/05/2020
Last Update Date	:	03/05/2020

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Directions to “ NICOLE MARIE BARDAJI ” Practice Location

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