MEDICARE: CROM REHABILITATION, LLC

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	2251S0007X	Sports Physical Therapist	1166310	TX
2	2251X0800X	Orthopedic Physical Therapist	1166310	TX
3	225100000X	Physical Therapist	1166310	TX

General Provider Information

NPI Number	:	1770821936
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CROM REHABILITATION, LLC

Provider Business Mailing Address
First Line	:	734 NORTH LOOP
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77009-1043
Country	:	US
Telephone Number	:	713-868-2766
Fax Number	:	713-868-7575

Provider Business Practice Location Address
First Line	:	734 NORTH LOOP
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77009-1043
Country	:	US
Telephone Number	:	713-868-2766
Fax Number	:	713-868-7575

Authorized Official
Title or Position	:	CEO
Name	:	DR. ROGELIO RIVERA JR.
Credential	:	PT, PHD, DPT, MCHES
Telephone Number	:	713-868-2766

Provider Enumeration Date	:	01/23/2013
Last Update Date	:	08/07/2023

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