Provider Demographics
NPI:1720227788
Name:SPERO REHABILITATION LLC
Entity Type:Organization
Organization Name:SPERO REHABILITATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:
Authorized Official - Last Name:BOUCHILLION
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:281-395-9090
Mailing Address - Street 1:23225 KINGSLAND BLVD
Mailing Address - Street 2:SUITE 600
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-2890
Mailing Address - Country:US
Mailing Address - Phone:281-395-9090
Mailing Address - Fax:
Practice Address - Street 1:23225 KINGSLAND BLVD
Practice Address - Street 2:SUITE 600
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-2890
Practice Address - Country:US
Practice Address - Phone:281-395-9090
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-16
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX668960000225100000X
TX225CA2400X
TX561830000225X00000X
235Z00000X, 261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225CA2400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation CounselorAssistive Technology PractitionerGroup - Single Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3539066Medicaid