MEDICARE: WILLIE CROMER PTA

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	225200000X	Physical Therapy Assistant	8687	CA

General Provider Information

NPI Number	:	1780473926
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIE CROMER PTA

Provider Business Mailing Address
First Line	:	8175 LIMONITE AVE STE A
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92509-6120
Country	:	US
Telephone Number	:	951-370-7033
Fax Number	:	951-370-7034

Provider Business Practice Location Address
First Line	:	8175 LIMONITE AVE STE A
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92509-6120
Country	:	US
Telephone Number	:	951-370-7033
Fax Number	:	951-370-7034

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/05/2025
Last Update Date	:	05/05/2025

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Directions to “ WILLIE CROMER PTA” Practice Location

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