Individual provider Active NPI

Pankaj Mamtora, R.P.T.

  • Physical Therapist
  • Stafford, TX
National Provider Identifier
1104123561
Registry record updated Sep 17, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
1319413 Issued in TX
Practice address
12603 Southwest Fwy Ste 101
Stafford, TX 77477-3841
Phone
(833) 733-6978
Fax
(833) 733-3778
NPI assigned
Feb 22, 2011
Last updated
Sep 17, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 17, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 1319413 TX Primary

Addresses

Primary practice location

12603 Southwest Fwy Ste 101
Stafford, TX 77477-3841

Mailing address

12603 Southwest Fwy Ste 101
Stafford, TX 77477-3841
Phone (833) 733-6978

Other practice location 1

24217 Kingsland Blvd
Katy, TX 77494-2976
Phone (833) 733-6978

Other practice location 2

17320 Red Oak Dr Ste 102
Houston, TX 77090-2646
Phone (833) 733-6978

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI, TX2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20110720000445 MI Practitioner - Physical Therapist in Private Practice 2961689211 Reassigns benefits to 1 organization
I20200303000059 TX Practitioner - Physical Therapist in Private Practice 2961689211 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Physical Therapy Services, Inc. Physical Therapist CurrentSince May 13, 2011 Accepting new patients
Theramedic Rehab Inc. CurrentSince Mar 3, 2011 Accepting new patients
Harone, PA PastSince Nov 1, 2016 Accepting new patients

Locations

5130 Coolidge Hwy
Royal Oak, MI 48073
Phone (248) 288-9500

26400 W 12 Mile Rd
Ste 25
Southfield, MI 48034
Phone (248) 565-4000

12603 Southwest Fwy
Ste 101
Stafford, TX 77477
Phone (281) 495-8258

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1298332800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1789603200000",
    "number": "1104123561",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12603 SOUTHWEST FWY STE 101",
            "city": "STAFFORD",
            "state": "TX",
            "postal_code": "774773841",
            "telephone_number": "833-733-6978",
            "fax_number": "833-733-3778"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12603 SOUTHWEST FWY STE 101",
            "city": "STAFFORD",
            "state": "TX",
            "postal_code": "774773841",
            "telephone_number": "833-733-6978",
            "fax_number": "833-733-3778"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "24217 Kingsland Blvd",
            "address_purpose": "LOCATION",
            "city": "Katy",
            "state": "TX",
            "postal_code": "774942976",
            "country_code": "US",
            "telephone_number": "833-733-6978",
            "fax_number": "833-733-3778",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "17320 Red Oak Dr Ste 102",
            "address_purpose": "LOCATION",
            "city": "Houston",
            "state": "TX",
            "postal_code": "770902646",
            "country_code": "US",
            "telephone_number": "833-733-6978",
            "fax_number": "833-733-3778",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MAMTORA",
        "first_name": "PANKAJ",
        "name_prefix": "Mr.",
        "credential": "R.P.T.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-02-22",
        "last_updated": "2026-09-17",
        "certification_date": "2026-09-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "TX",
            "license": "1319413",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Stafford, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2026; 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.