Provider Demographics
NPI:1780473926
Name:CROMER, WILLIE (PTA)
Entity type:Individual
Prefix:
First Name:WILLIE
Middle Name:
Last Name:CROMER
Suffix:
Gender:
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8175 LIMONITE AVE STE A
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92509-6120
Mailing Address - Country:US
Mailing Address - Phone:951-370-7033
Mailing Address - Fax:951-370-7034
Practice Address - Street 1:8175 LIMONITE AVE STE A
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92509-6120
Practice Address - Country:US
Practice Address - Phone:951-370-7033
Practice Address - Fax:951-370-7034
Is Sole Proprietor?:No
Enumeration Date:2025-05-05
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8687225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant