MEDICARE: INCLUSIVE WELLNESS & REHABILITATION 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	207Q00000X	Family Medicine Physician	L6405	TX
2	207R00000X	Internal Medicine Physician	L6405	TX
3	2081P2900X	Pain Medicine (Physical Medicine & Rehabilitation) Physician	L6405	TX
4	208D00000X	General Practice Physician	L6405	TX
5	261QM1300X	Multi-Specialty Clinic/Center	801599338	TX

General Provider Information

NPI Number	:	1891055026
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INCLUSIVE WELLNESS & REHABILITATION PLLC

Provider Business Mailing Address
First Line	:	5644 WESTHEIMER RD # 347
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77056-4002
Country	:	US
Telephone Number	:	832-407-2276
Fax Number	:

Provider Business Practice Location Address
First Line	:	6550 MAPLERIDGE ST STE 115
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77081-4629
Country	:	US
Telephone Number	:	713-370-2274
Fax Number	:

Authorized Official
Title or Position	:	MEMBER
Name	:	RONALD A GREEN
Credential	:	MD
Telephone Number	:	713-370-2274

Provider Enumeration Date	:	05/22/2012
Last Update Date	:	05/22/2012

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