MEDICARE: RENEE L CROCKFORD

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	225700000X	Massage Therapist	12018	TX

General Provider Information

NPI Number	:	1053163212
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RENEE L CROCKFORD

Provider Business Mailing Address
First Line	:	PO BOX 440654
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77244-0654
Country	:	US
Telephone Number	:	832-277-5447
Fax Number	:

Provider Business Practice Location Address
First Line	:	1652 S DAIRY ASHFORD RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77077-3822
Country	:	US
Telephone Number	:	669-799-1988
Fax Number	:

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

Provider Enumeration Date	:	04/02/2024
Last Update Date	:	04/02/2024

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Directions to “ RENEE L CROCKFORD ” Practice Location

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