MEDICARE: ROUTE 2 RECOVERY PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1588316004
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROUTE 2 RECOVERY PLLC

Provider Business Mailing Address
First Line	:	7158 HERON DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77087-6724
Country	:	US
Telephone Number	:	832-983-7112
Fax Number	:

Provider Business Practice Location Address
First Line	:	7158 HERON DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77087-6724
Country	:	US
Telephone Number	:	832-983-7112
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. JENNY KATHYA CHAVEZ
Credential	:	PT, DPT
Telephone Number	:	346-397-6898

Provider Enumeration Date	:	01/25/2022
Last Update Date	:	01/25/2022

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