Provider Demographics
NPI:1467495317
Name:PERILLOUX, CRAIG RANDALL (PT)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:RANDALL
Last Name:PERILLOUX
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2414 MILLS CREEK DR
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77339-3095
Mailing Address - Country:US
Mailing Address - Phone:281-358-7923
Mailing Address - Fax:
Practice Address - Street 1:605 ROCKMEAD DRIVE
Practice Address - Street 2:SUITE 200
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339
Practice Address - Country:US
Practice Address - Phone:281-348-9588
Practice Address - Fax:281-348-2150
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2009-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1116135225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1116135OtherPHYSICAL THERAPY LICENSE
TX8A7554Medicare PIN