NPIMap

Organization Active NPI

Sports Rehabilitation Specialists, Inc

  • Physical Therapy Clinic/Center
  • Fort Worth, TX
National Provider Identifier
1003929357
Registry record updated Nov 29, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
License
5292500 Issued in TX
Legal business name
SPORTS REHABILITATION SPECIALISTS, INC
Practice address
1901 Cooper St
Ft Worth, TX 76104
Phone
(817) 877-8977
Fax
(817) 877-1106
NPI assigned
Aug 17, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 29, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Sheila Marie Pickrel, PTNPI 1710090063
Title
Vice President
Phone
(817) 877-8977

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Clinic/Center 261QP2000X
Physical Therapy Clinic/Center 261QP2000X 5292500 TX Primary

Addresses

Primary practice location

1901 Cooper St
Ft Worth, TX 76104

Mailing address

1901 Cooper St
Ft Worth, TX 76104
Phone (817) 877-8977

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050323000365 TX Part B Supplier - Clinic/Group Practice 1759337744 Receives reassigned benefits from 3 practitioners
Practice locations: Fort Worth, TX

National Provider Directory

National Provider Directory

Locations

1550 W Rosedale St
Ste 522
Fort Worth, TX 76104
Phone (817) 877-8977

1901 Cooper St
Ft Worth, TX 76104
Phone (817) 877-8977

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1155772800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1196294400000",
    "number": "1003929357",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1901 COOPER ST",
            "city": "FT WORTH",
            "state": "TX",
            "postal_code": "76104",
            "telephone_number": "817-877-8977",
            "fax_number": "817-877-1106"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1901 COOPER ST",
            "city": "FT WORTH",
            "state": "TX",
            "postal_code": "76104",
            "telephone_number": "817-877-8977",
            "fax_number": "817-877-1106"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPORTS REHABILITATION SPECIALISTS, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-17",
        "last_updated": "2007-11-29",
        "status": "A",
        "authorized_official_last_name": "PICKREL",
        "authorized_official_first_name": "SHEILA",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "817-877-8977",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "TX",
            "license": "5292500",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Worth, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 29, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.