Individual provider Active NPI

Riley Wood

  • Physical Therapist
  • Fort Worth, TX
National Provider Identifier
1679151872
Registry record updated Apr 29, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
1343252
Practice address
4108 Boat Club Rd
Fort Worth, TX 76135-2604
Phone
(817) 238-9295
NPI assigned
Mar 30, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 29, 2021

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 1343252 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

Other identifiers 1

IdentifierTypeStateIssuer
1343252OtherTXPT LICENSE

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210503001786 TX Practitioner - Physical Therapist in Private Practice 6103235270 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Sportherapy LLCGroup PAC ID 0749536308, 45 clinicians

Practice addresses (Care Compare)

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

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Sportherapy LLC Physical Therapist CurrentSince Mar 29, 2021 Accepting new patients
Sportherapy Southwest, PC Physical Therapist PastSince Mar 29, 2021 Accepting new patients

Locations

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

167 Regency Pkwy
Ste 105
Mansfield, TX 76063
Phone (682) 341-0076

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

Organizations & group practices 2

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": "1617062400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1619654400000",
    "number": "1679151872",
    "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": "WOOD",
        "first_name": "RILEY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-03-30",
        "last_updated": "2021-04-29",
        "certification_date": "2021-04-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": null,
            "license": "1343252",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PT LICENSE",
            "identifier": "1343252",
            "state": "TX"
        }
    ],
    "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 Apr 29, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.