Healthcare Provider Details

I. General information

NPI: 1477287159
Provider Name (Legal Business Name): SENIOR REHAB INNOVATORS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2022
Last Update Date: 07/11/2022
Certification Date: 07/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6262 HOME PORT DR APT 1530
FORT WORTH TX
76131-2389
US

IV. Provider business mailing address

6262 HOME PORT DR APT 1530
FORT WORTH TX
76131-2389
US

V. Phone/Fax

Practice location:
  • Phone: 419-378-1566
  • Fax:
Mailing address:
  • Phone: 419-378-1566
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name: PRADEEP RAPALLI
Title or Position: OWNER
Credential: PT, DPT, MBA
Phone: 419-378-1566