Individual provider Active NPI

Victoria Anne Lopez, PT

  • Physical Therapist
  • Fort Worth, TX
National Provider Identifier
1174830491
Registry record updated Jul 15, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
1216613 Issued in TX
Practice address
12650 N Beach St Ste 150
Fort Worth, TX 76244-4243
Phone
(817) 402-0218
Fax
(844) 537-3572
NPI assigned
Sep 8, 2010
Last updated
Jul 15, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 15, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 1216613 TX Primary
Physical Therapist 225100000X PT60135208 WA

Addresses

Primary practice location

12650 N Beach St Ste 150
Fort Worth, TX 76244-4243

Mailing address

790 Remington Blvd
Bolingbrook, IL 60440-4909

Other identifiers 1

IdentifierTypeStateIssuer
G8895452OtherWAMEDICARE

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130605000171 TX Practitioner - Physical Therapist in Private Practice 1254527229 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

245 W State Hwy 114
Suite 320
Southlake, TX 76092-3638
Phone (817) 873-5311

Merit-based Incentive Payment System (MIPS)

Final score
85.56 of 100Reported as group
Quality
89.48
Improvement activities
40
Cost
71.16

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Ideal Physical Therapy of Texas LLC Physical Therapist CurrentSince Jun 15, 2019 Accepting new patients
Ideal Physical Therapy of Texas LLC CurrentSince Jun 15, 2019 Accepting new patients
Cascade Rehabilitation Associates, PLLC Physical Therapist Past Accepting new patients
Southlake Specialty Hospital, LLC Past Accepting new patients

Locations

790 Remington Blvd
Bolingbrook, IL 60440

17051 Dallas Pkwy
Ste 450
Addison, TX 75001
Phone (214) 272-8561

4100 Fairway Dr
Ste 400
Carrollton, TX 75010
Phone (972) 394-3325

379 E FM 1382
Ste 100
Cedar Hill, TX 75104
Phone (972) 460-4490

4843 Colleyville Blvd
Ste 221
Colleyville, TX 76034
Phone (817) 576-7520

106 N Denton Tap Rd
Ste 220
Coppell, TX 75019
Phone (469) 528-6437

1050 Flower Mound Rd
Ste 140
Flower Mound, TX 75028
Phone (469) 702-5947

2600 W 7th St
Ste 137
Fort Worth, TX 76107
Phone (682) 233-6462

4617 W Bailey Boswell Rd
Fort Worth, TX 76179
Phone (682) 350-4106

1215 W Pioneer Pkwy
Ste 200
Grand Prairie, TX 75051
Phone (972) 400-4752

1401 William D Tate Ave
Ste 300
Grapevine, TX 76051
Phone (817) 527-3377

861 North Tarrant Pkwy
Unit 100
Keller, TX 76248
Phone (817) 918-2480

5121 Rufe Snow Dr
Ste 110
North Richland Hills, TX 76180
Phone (817) 345-4367

245 W State Highway 114
Ste 320
Southlake, TX 76092
Phone (817) 873-5311

Interoperability endpoints

  • FHIR API: https://epproxy.texashealth.org/FHIR/api/FHIR/DSTU2/

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": "1283904000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721001600000",
    "number": "1174830491",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "790 REMINGTON BLVD",
            "city": "BOLINGBROOK",
            "state": "IL",
            "postal_code": "604404909"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12650 N BEACH ST STE 150",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "762444243",
            "telephone_number": "817-402-0218",
            "fax_number": "844-537-3572"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LOPEZ",
        "first_name": "VICTORIA",
        "middle_name": "ANNE",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-09-08",
        "last_updated": "2024-07-15",
        "certification_date": "2024-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "TX",
            "license": "1216613",
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WA",
            "license": "PT60135208",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "G8895452",
            "state": "WA"
        }
    ],
    "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 Jul 15, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.