Provider Demographics
NPI:1285291120
Name:BHUSARI, RENUKA (MPTH)
Entity type:Individual
Prefix:
First Name:RENUKA
Middle Name:
Last Name:BHUSARI
Suffix:
Gender:F
Credentials:MPTH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4407 STERLING HEIGHTS LN
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-4753
Mailing Address - Country:US
Mailing Address - Phone:806-786-5298
Mailing Address - Fax:
Practice Address - Street 1:5201 S WILLOW DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77035-4808
Practice Address - Country:US
Practice Address - Phone:713-721-0297
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-27
Last Update Date:2019-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1209907225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist