Provider Demographics
NPI:1265867063
Name:MANKERIOUS, BASEM (PT, DPT)
Entity type:Individual
Prefix:
First Name:BASEM
Middle Name:
Last Name:MANKERIOUS
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5517 S HULEN ST
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76132-2262
Mailing Address - Country:US
Mailing Address - Phone:817-439-6200
Mailing Address - Fax:817-439-6211
Practice Address - Street 1:5517 S HULEN ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-2262
Practice Address - Country:US
Practice Address - Phone:817-439-6200
Practice Address - Fax:817-439-6211
Is Sole Proprietor?:No
Enumeration Date:2013-09-11
Last Update Date:2025-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1232378225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist