Active NPI
Mallory Powell, DPT
- Physical Therapist
- Fort Worth, TX
National Provider Identifier
1194476614
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- Practice address
- 4108 Boat Club Rd
Fort Worth, TX 76135-2604 - Phone
- (817) 238-9295
- NPI assigned
- Jan 17, 2022
- Last updated
- Jan 17, 2022
- 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 | Primary |
Addresses
Primary practice location
4108 Boat Club Rd
Fort Worth, TX 76135-2604
Mailing address
6501 Harris Pkwy
Fort Worth, TX 76132-6102
Phone (817) 370-9891
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
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sportherapy Southwest, PC | Physical Therapist | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- 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": "1642377600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1642377600000",
"number": "1194476614",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6501 HARRIS PKWY",
"city": "FORT WORTH",
"state": "TX",
"postal_code": "761326102",
"telephone_number": "817-370-9891"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4108 BOAT CLUB RD",
"city": "FORT WORTH",
"state": "TX",
"postal_code": "761352604",
"telephone_number": "817-238-9295"
}
],
"practiceLocations": [],
"basic": {
"last_name": "POWELL",
"first_name": "MALLORY",
"credential": "DPT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-01-17",
"last_updated": "2022-01-17",
"certification_date": "2022-01-17",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": null,
"license": null,
"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 Jan 17, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.