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Evan Boullosa, LPTA
NPI 1780412585 · on the registry since 2024
Practice
- Address
- 3265 Koehler Rd Bldg 1385
Fort Sam Houston, TX 78234 - Phone
- (210) 221-5033
- Clinicians at this address
- 2
Registry record
- Primary taxonomy
- 225200000X
225200000X
- Licence states on file
- TX
From the registry's licence fields, which are often incomplete.
- Sex
- Male
- Record last updated
- 2024-07-23
Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Texas