NPIMap

Organization Active NPI

Cleburne Physical Therapy & Sports Rehabilitation, Inc.

  • Physical Therapist
  • Cleburne, TX
National Provider Identifier
1205800802
Registry record updated Dec 6, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
6019700 Issued in TX
Legal business name
CLEBURNE PHYSICAL THERAPY & SPORTS REHABILITATION, INC.
Practice address
1014 N Nolan River Rd
Cleburne, TX 76033-7925
Phone
(817) 641-8617
Fax
(817) 645-6966
NPI assigned
Feb 13, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 6, 2023

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

Authorized official

Name
Bobby Ismail
Title
President
Phone
(209) 353-1988

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225100000X 6019700 TX Primary

Addresses

Primary practice location

1014 N Nolan River Rd
Cleburne, TX 76033-7925

Mailing address

1014 N Nolan River Road
Cleburne, TX 76033-7925
Phone (817) 641-8617

Other identifiers 3

IdentifierTypeStateIssuer
CB3646OtherTXRAILROAD PIN
00T67YOtherTXBLUE CROSS BLUE SHIELD OF TEXAS
087713602MedicaidTX

Other names 1

  • Cleburne Physical Therapy Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031124000592 TX Part B Supplier - Clinic/Group Practice 1052221256 Receives reassigned benefits from 3 practitioners
Practice locations: Burleson, TX; Cleburne, TX

National Provider Directory

National Provider Directory

Locations

1014 N Nolan River Rd
Cleburne, TX 76033
Phone (817) 641-8617

Practitioners & affiliated clinicians

Practitioners 22

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 22

NPI Registry JSON

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

{
    "created_epoch": "1139788800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1701820800000",
    "number": "1205800802",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1014 N NOLAN RIVER ROAD",
            "city": "CLEBURNE",
            "state": "TX",
            "postal_code": "760337925",
            "telephone_number": "817-641-8617",
            "fax_number": "817-645-6966"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1014 N NOLAN RIVER RD",
            "city": "CLEBURNE",
            "state": "TX",
            "postal_code": "760337925",
            "telephone_number": "817-641-8617",
            "fax_number": "817-645-6966"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLEBURNE PHYSICAL THERAPY & SPORTS REHABILITATION, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-13",
        "last_updated": "2023-12-06",
        "certification_date": "2023-12-06",
        "status": "A",
        "authorized_official_last_name": "ISMAIL",
        "authorized_official_first_name": "BOBBY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "209-353-1988"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "TX",
            "license": "6019700",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD PIN",
            "identifier": "CB3646",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD OF TEXAS",
            "identifier": "00T67Y",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "087713602",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Cleburne Physical Therapy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Cleburne Physical Therapy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Cleburne, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2023; 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.