MEDICARE: REHABOLOGY PLLC

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	2081N0008X	Neuromuscular Medicine (Physical Medicine & Rehabilitation) Physician
2	208100000X	Physical Medicine & Rehabilitation Physician

General Provider Information

NPI Number	:	1699493304
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REHABOLOGY PLLC

Provider Business Mailing Address
First Line	:	3302 TIMBERGROVE OAKS ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77008-6476
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3302 TIMBERGROVE OAKS ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77008-6476
Country	:	US
Telephone Number	:	832-547-3508
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	RYAN ARDOIN
Credential	:	DPT
Telephone Number	:	832-547-3508

Provider Enumeration Date	:	08/18/2022
Last Update Date	:	08/18/2022

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