NPIMap

Organization Active NPI

Sportherapy Southwest, PC

  • Comprehensive Outpatient Rehabilitation Facility (CORF)
  • Fort Worth, TX
National Provider Identifier
1801812698
Registry record updated May 20, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Comprehensive Outpatient Rehabilitation Facility (CORF)Taxonomy code 261QR0401X
License
605100000 Issued in TX
Legal business name
SPORTHERAPY SOUTHWEST, PC
Practice address
6037 Harris Pkwy
Fort Worth, TX 76132-4103
Phone
(817) 370-9891
Fax
(817) 370-9894
NPI assigned
Jul 14, 2006
Last updated
May 20, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 20, 2014

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

Authorized official

Name
Mr. Steven B Lackey
Title
Business Director
Phone
(817) 370-9891

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225100000X 605100000 TX
Rehabilitation Clinic/Center 261QR0400X 605100000 TX
Comprehensive Outpatient Rehabilitation Facility (CORF) 261QR0401X 605100000 TX Primary

Addresses

Primary practice location

6037 Harris Pkwy
Fort Worth, TX 76132-4103

Mailing address

6037 Harris Pkwy
Fort Worth, TX 76132-4103
Phone (817) 370-9891

National Provider Directory

National Provider Directory

Locations

4744 Bryant Irvin Rd
Ste 934
Fort Worth, TX 76132
Phone (817) 370-9891

4504 Boat Club Rd
Ft Worth, TX 76135
Phone (817) 237-0515

4625 Boat Club Rd
Ft Worth, TX 76135
Phone (817) 238-9295

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

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

Practitioners & affiliated clinicians

Practitioners 122

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 122

NPI Registry JSON

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

{
    "created_epoch": "1152835200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1400544000000",
    "number": "1801812698",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6037 HARRIS PKWY",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761324103",
            "telephone_number": "817-370-9891",
            "fax_number": "817-370-9894"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6037 HARRIS PKWY",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761324103",
            "telephone_number": "817-370-9891",
            "fax_number": "817-370-9894"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPORTHERAPY SOUTHWEST, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-14",
        "last_updated": "2014-05-20",
        "status": "A",
        "authorized_official_last_name": "LACKEY",
        "authorized_official_first_name": "STEVEN",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "BUSINESS DIRECTOR",
        "authorized_official_telephone_number": "817-370-9891",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "TX",
            "license": "605100000",
            "primary": false
        },
        {
            "code": "261QR0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation",
            "state": "TX",
            "license": "605100000",
            "primary": false
        },
        {
            "code": "261QR0401X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)",
            "state": "TX",
            "license": "605100000",
            "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 20, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.