MEDICARE: BASEM MANKERIOUS PT, DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	1232378	TX

General Provider Information

NPI Number	:	1265867063
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BASEM MANKERIOUS PT, DPT

Provider Business Mailing Address
First Line	:	5517 S HULEN ST
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76132-2262
Country	:	US
Telephone Number	:	817-439-6200
Fax Number	:	817-439-6211

Provider Business Practice Location Address
First Line	:	5517 S HULEN ST
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76132-2262
Country	:	US
Telephone Number	:	817-439-6200
Fax Number	:	817-439-6211

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/11/2013
Last Update Date	:	07/22/2025

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