NPIMap

Organization Active NPI

Midland Physical Therapy and Sports Rehabilitation Inc

  • Physical Therapist
  • Midland, TX
National Provider Identifier
1316148992
Registry record updated Jul 9, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT158345 Issued in TX
Legal business name
MIDLAND PHYSICAL THERAPY AND SPORTS REHABILITATION INC
Practice address
2420 W Illinois Ave
Midland, TX 79701-6337
Phone
(432) 687-0235
Fax
(432) 570-8713
NPI assigned
May 30, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2024

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

Authorized official

Name
Amanda Streeter
Title
Chief Administrative Officer
Phone
(800) 699-9395

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225100000X PT158345 TX Primary

Addresses

Primary practice location

2420 W Illinois Ave
Midland, TX 79701-6337

Mailing address

PO Box 932184
Atlanta, GA 31193-2184

Other identifiers 1

IdentifierTypeStateIssuer
82979TOtherTXBLUE CROSS BLUE SHIELDS

Other names 1

  • Midland 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
O20220525002712 TX Part B Supplier - Physical/Occupational Therapy Group in Private Practice 8820253883 Receives reassigned benefits from 12 practitioners
Practice locations: Midland, TX

National Provider Directory

National Provider Directory

Locations

2420 W Illinois Ave
Midland, TX 79701
Phone (432) 687-0235

Practitioners & affiliated clinicians

Practitioners 12

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

NPI Registry JSON

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

{
    "created_epoch": "1180483200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1720483200000",
    "number": "1316148992",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 932184",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "311932184"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2420 W ILLINOIS AVE",
            "city": "MIDLAND",
            "state": "TX",
            "postal_code": "797016337",
            "telephone_number": "432-687-0235",
            "fax_number": "432-570-8713"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIDLAND PHYSICAL THERAPY AND SPORTS REHABILITATION INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-30",
        "last_updated": "2024-07-09",
        "certification_date": "2024-07-09",
        "status": "A",
        "authorized_official_last_name": "STREETER",
        "authorized_official_first_name": "AMANDA",
        "authorized_official_title_or_position": "CHIEF ADMINISTRATIVE OFFICER",
        "authorized_official_telephone_number": "800-699-9395"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "TX",
            "license": "PT158345",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELDS",
            "identifier": "82979T",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Midland Physical Therapy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Midland, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2024; 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.