Individual provider Active NPI

Leonardo Cervantes

  • Physical Therapist
  • Fort Worth, TX
National Provider Identifier
1508520289
Registry record updated May 11, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Practice address
4108 Boat Club Rd
Fort Worth, TX 76135-2604
Phone
(817) 238-9295
NPI assigned
Oct 28, 2021
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 11, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X Primary

Addresses

Primary practice location

4108 Boat Club Rd
Fort Worth, TX 76135-2604

Mailing address

4108 Boat Club Rd
Fort Worth, TX 76135-2604
Phone (817) 238-9295

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20211122000996 TX Practitioner - Physical Therapist in Private Practice 7719376219 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Texas Luna Care Physical Therapy LLC Physical Therapist CurrentSince May 31, 2022 Accepting new patients
Sportherapy LLC Physical Therapist CurrentSince Nov 10, 2021 Accepting new patients
Sportherapy Southwest, PC Physical Therapist PastSince Oct 31, 2021 Accepting new patients

Locations

11909 Preston Rd
Ste 1482
Dallas, TX 75230
Phone (214) 446-1601

12457 Timberland Blvd
Ste 205
Fort Worth, TX 76244
Phone (682) 213-3006

4108 Boat Club Rd
Lake Worth, TX 76135
Phone (817) 238-9295

180 State St
Ste 225
Southlake, TX 76092
Phone (682) 429-7066

965 Hilltop Dr
Weatherford, TX 76086
Phone (817) 370-9891

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1635379200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1778457600000",
    "number": "1508520289",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4108 BOAT CLUB RD",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761352604",
            "telephone_number": "817-238-9295"
        },
        {
            "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": "CERVANTES",
        "first_name": "LEONARDO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-10-28",
        "last_updated": "2026-05-11",
        "certification_date": "2021-10-28",
        "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 May 11, 2026; 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.