Provider Demographics
NPI:1992286959
Name:FEGADE, VRUSHALI
Entity type:Individual
Prefix:
First Name:VRUSHALI
Middle Name:
Last Name:FEGADE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 HOLLOW TREE LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77090-2803
Mailing Address - Country:US
Mailing Address - Phone:832-705-8700
Mailing Address - Fax:832-705-8701
Practice Address - Street 1:2930 CYPRESS GROVE MEADOW DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77014-1574
Practice Address - Country:US
Practice Address - Phone:281-451-4420
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-27
Last Update Date:2018-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2089936225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant