Individual provider Active NPI

Maria Rousseva, PT, DPT

  • Physical Therapist
  • Burleson, TX
National Provider Identifier
1861062804
Registry record updated Jul 1, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
1346692 Issued in TX
Practice address
12550 South Fwy Ste 106
Burleson, TX 76028-8438
Phone
(817) 426-4401
Fax
(817) 426-4410
NPI assigned
Jul 1, 2021
Last updated
Jul 1, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 1, 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 1346692 TX Primary

Addresses

Primary practice location

12550 South Fwy Ste 106
Burleson, TX 76028-8438

Mailing address

12550 South Fwy Ste 106
Burleson, TX 76028-8438
Phone (817) 426-4401

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210712002771 TX Practitioner - Physical Therapist in Private Practice 2264834324 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Sportherapy LLCGroup PAC ID 0749536308, 45 clinicians

Practice addresses (Care Compare)

6501 Harris Pkwy
Fort Worth, TX 76132-6102
Phone (817) 370-9891

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
1346692TXMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Crossroads Physical Therapy Limited Partnership Physical Therapist CurrentSince Jun 29, 2021 Accepting new patients
Sportherapy LLC Physical Therapist CurrentSince Aug 29, 2022 Accepting new patients
Crossroads Physical Therapy Limited Partnership Physical Therapist CurrentSince Jun 29, 2021 Accepting new patients
Sportherapy Southwest, PC Physical Therapist PastSince Aug 29, 2022 Accepting new patients
Gateway Partners Inc Physical Therapist PastSince Dec 15, 2011 Accepting new patients

Locations

1650 Lyndon Farm Ct
Ste 300
Louisville, KY 40223
Phone (726) 202-3039

12550 South Fwy
Ste 106
Burleson, TX 76028
Phone (817) 426-4401

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

3690 W Wheatland Rd
Ste 10
Dallas, TX 75237
Phone (972) 296-6645

3824 S Carrier Pkwy
Ste 490
Grand Prairie, TX 75052
Phone (972) 262-9972

8857 Davis Blvd
Ste 100
Keller, TX 76248
Phone (817) 413-8700

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

Organizations & group practices 5

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

NPI Registry JSON

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

{
    "created_epoch": "1625097600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1625097600000",
    "number": "1861062804",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12550 SOUTH FWY STE 106",
            "city": "BURLESON",
            "state": "TX",
            "postal_code": "760288438",
            "telephone_number": "817-426-4401",
            "fax_number": "817-426-4410"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12550 SOUTH FWY STE 106",
            "city": "BURLESON",
            "state": "TX",
            "postal_code": "760288438",
            "telephone_number": "817-426-4401",
            "fax_number": "817-426-4410"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROUSSEVA",
        "first_name": "MARIA",
        "credential": "PT, DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-07-01",
        "last_updated": "2021-07-01",
        "certification_date": "2021-07-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "TX",
            "license": "1346692",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Burleson, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 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.