Active NPI
Amber Pippen, P.T.
- Physical Therapist
- Fort Worth, TX
National Provider Identifier
1104115443
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 1203969
- Practice address
- 4625 Boat Club Rd
Fort Worth, TX 76135-7022 - Phone
- (817) 238-9295
- Fax
- (817) 238-9299
- NPI assigned
- Apr 6, 2011
- 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 | 1203969 | TX | Primary |
Addresses
Primary practice location
4625 Boat Club Rd
Fort Worth, TX 76135-7022
Mailing address
6037 Harris Pkwy
Fort Worth, TX 76132-4103
Phone (817) 370-9891
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 192079501 | Medicaid | TX |
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1203969 | TX | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Dacus Chiropractic PLLC | Past | Accepting new patients | |
| Sportherapy Southwest, PC | Physical Therapist | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Chiropractor
- Mansfield, TX
- NPI 1972741775
-
- Comprehensive Outpatient Rehabilitation Facility (CORF)
- Fort Worth, TX
- NPI 1801812698
Physical Therapist
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1302048000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1302048000000",
"number": "1104115443",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6037 HARRIS PKWY",
"city": "FORT WORTH",
"state": "TX",
"postal_code": "761324103",
"telephone_number": "817-370-9891",
"fax_number": "817-370-9891"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4625 BOAT CLUB RD",
"city": "FORT WORTH",
"state": "TX",
"postal_code": "761357022",
"telephone_number": "817-238-9295",
"fax_number": "817-238-9299"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PIPPEN",
"first_name": "AMBER",
"credential": "P.T.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-04-06",
"last_updated": "2011-04-06",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "TX",
"license": "1203969",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "192079501",
"state": "TX"
}
],
"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 Apr 6, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.