Senior Rehab Innovators PLLC

Primary specialty

Geriatric Physical TherapistTaxonomy code 2251G0304X

Legal business name

SENIOR REHAB INNOVATORS PLLC

Doing business as

Active Aging Physical Therapy

Practice address

6262 Home Port Dr Apt 1530
Fort Worth, TX 76131-2389

Phone

(419) 378-1566

NPI assigned

Jul 11, 2022

Organization subpart

No

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

Authorized official

Name

Pradeep Rapalli, PT, DPT, MBANPI 1912247610

Title

Owner

Phone

(419) 378-1566

Specialties & licenses 1

Addresses

Other names 1

• Active Aging Physical Therapy Doing business as

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Practitioners 1

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

• Pradeep Rapalli, PT

  • Physical Therapist
  • Athens, TX
  • NPI 1912247610
  Medicare reassignment Authorized official

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

{
    "created_epoch": "1657497600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1657497600000",
    "number": "1477287159",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6262 HOME PORT DR APT 1530",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761312389",
            "telephone_number": "419-378-1566"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6262 HOME PORT DR APT 1530",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761312389",
            "telephone_number": "419-378-1566"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SENIOR REHAB INNOVATORS PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-07-11",
        "last_updated": "2022-07-11",
        "certification_date": "2022-07-11",
        "status": "A",
        "authorized_official_last_name": "RAPALLI",
        "authorized_official_first_name": "PRADEEP",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "419-378-1566",
        "authorized_official_credential": "PT, DPT, MBA"
    },
    "taxonomies": [
        {
            "code": "2251G0304X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist, Geriatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Active Aging Physical Therapy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Geriatric Physical Therapist in Fort Worth, TX
• Providers in Fort Worth, TX by specialty
• Geriatric Physical Therapist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2022; 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.