Physical Therapy of Mansfield,LLC

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

License

658850000 Issued in TX

Legal business name

PHYSICAL THERAPY OF MANSFIELD,LLC

Practice address

1580 Highway 287 N
1580 Hwy 287 N
Mansfield, TX 76063-7593

Phone

(817) 473-4684

Fax

(817) 473-1170

NPI assigned

Aug 11, 2005

Organization subpart

No

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

Authorized official

Name

Mr. David Alan Roberson

Title

Manager

Phone

(817) 473-4684

Specialties & licenses 1

Addresses

Other identifiers 6

Other names 1

• SUSAN G. ROBERSON Former legal business name

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

{
    "created_epoch": "1123718400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1416441600000",
    "number": "1124020979",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 501",
            "address_2": "1580 HWY 287 N",
            "city": "MANSFIELD",
            "state": "TX",
            "postal_code": "760630501",
            "telephone_number": "817-473-4684",
            "fax_number": "817-473-1170"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1580 HIGHWAY 287 N",
            "address_2": "1580 HWY 287 N",
            "city": "MANSFIELD",
            "state": "TX",
            "postal_code": "760637593",
            "telephone_number": "817-473-4684",
            "fax_number": "817-473-1170"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHYSICAL THERAPY OF MANSFIELD,LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-11",
        "last_updated": "2014-11-20",
        "status": "A",
        "authorized_official_last_name": "ROBERSON",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "ALAN",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "817-473-4684",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "TX",
            "license": "658850000",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PT LICENSE",
            "identifier": "135244",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OWCP FED#",
            "identifier": "612949000",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLINIC REGISTRATION",
            "identifier": "604770000",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "658850000",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OLD TAX ID",
            "identifier": "752472481",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "DG4667",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SUSAN G. ROBERSON",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Minu Bijo Philip, PMHNP-BC
• Alexa D Philipose, PA
• Monica Leigh Phillips, FNP
• Rita Cathy Phillips, M.D.
• Hoa Ngoc Phung, O.D
• Taylor Renee Piacente, DPT, PT
• Picasso Dental-Mansfield PLLC
• Megan R Pickens, LPC-S
• Dammun Martin Pierce, D.O.
• Rachel Ann Pike

• Physical Therapy Clinic/Center in Mansfield, TX
• Providers in Mansfield, TX by specialty
• Physical Therapy Clinic/Center in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.