Healthcare Provider Details

I. General information

NPI: 1689328759
Provider Name (Legal Business Name): JASON RIVERS DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2022
Last Update Date: 02/08/2022
Certification Date: 02/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10125 KATY FWY STE 101
HOUSTON TX
77024-1287
US

IV. Provider business mailing address

4151 SORENSON DR
PEARLAND TX
77584-9444
US

V. Phone/Fax

Practice location:
  • Phone: 713-242-2270
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number1334935
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: