Individual
EVAN BOULLOSA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPTA
Contact information
Practice address
3265 KOEHLER RD BLDG 1385, FORT SAM HOUSTON, TX 78234-7587
(210) 221-5033
Mailing address
227 DWYER AVE APT 210, SAN ANTONIO, TX 78204-1238
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2159129
TX
Other
Enumeration date
07/23/2024
Last updated
07/23/2024
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