Provider Demographics
NPI:1700107257
Name:ABRAHAM, ANISH ((PT))
Entity Type:Individual
Prefix:
First Name:ANISH
Middle Name:
Last Name:ABRAHAM
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 1:5771 ENID ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77009-1208
Mailing Address - Country:US
Mailing Address - Phone:713-880-4400
Mailing Address - Fax:713-869-8637
Practice Address - Street 1:9940 W SAM HOUSTON PKWY S STE 320
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77099-5104
Practice Address - Country:US
Practice Address - Phone:832-300-2626
Practice Address - Fax:832-300-2625
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-18
Last Update Date:2010-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1150110225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist