Provider Demographics
NPI:1174790281
Name:BAUTISTA, FILEMON (PT)
Entity type:Individual
Prefix:MR
First Name:FILEMON
Middle Name:
Last Name:BAUTISTA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 MAIN ST
Mailing Address - Street 2:SUITE 602
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77469-3247
Mailing Address - Country:US
Mailing Address - Phone:281-341-2874
Mailing Address - Fax:281-341-3012
Practice Address - Street 1:7731 SOUTHWEST FWY
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074-1815
Practice Address - Country:US
Practice Address - Phone:713-456-5221
Practice Address - Fax:713-456-5229
Is Sole Proprietor?:No
Enumeration Date:2008-05-08
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1058535225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist