Active NPI
Andreana Raina Rosa Trinidad Crucillo, PT
- Physical Therapist
- Houston, TX
National Provider Identifier
1245990738
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 1350377
- Practice address
- 6621 Fannin St
Houston, TX 77030-2399 - Phone
- (832) 824-1000
- NPI assigned
- Dec 23, 2021
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 1350377 | TX | Primary |
Addresses
Primary practice location
6621 Fannin St
Houston, TX 77030-2399
Mailing address
13549 Ithaca Cresent Lane
Rosharon, TX 77583
Phone (956) 990-8349
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1350377 | TX | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1640217600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1677542400000",
"number": "1245990738",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "13549 ITHACA CRESENT LANE",
"city": "ROSHARON",
"state": "TX",
"postal_code": "77583",
"telephone_number": "956-990-8349"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6621 FANNIN ST",
"city": "HOUSTON",
"state": "TX",
"postal_code": "770302399",
"telephone_number": "832-824-1000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CRUCILLO",
"first_name": "ANDREANA RAINA ROSA",
"middle_name": "TRINIDAD",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-12-23",
"last_updated": "2023-02-28",
"certification_date": "2023-02-28",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "TX",
"license": "1350377",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Houston, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.