Healthcare Provider Details

I. General information

NPI: 1871251033
Provider Name (Legal Business Name): XTREME RECOVERY & REHAB LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2021
Last Update Date: 12/06/2021
Certification Date: 12/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 W GULF BANK RD STE A
HOUSTON TX
77037-2365
US

IV. Provider business mailing address

10906 LOST STONE DR
TOMBALL TX
77375-0062
US

V. Phone/Fax

Practice location:
  • Phone: 832-202-5810
  • Fax:
Mailing address:
  • Phone: 832-202-5810
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: MAJOR RIZVI
Title or Position: PRESIDENT
Credential:
Phone: 832-202-5810