LAKE FORK PHYSICAL THERAPY, PLLC
NPI 1154540540
Physical Therapist in Emory, TX
About Lake Fork Physical Therapy, Pllc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
LAKE FORK PHYSICAL THERAPY, PLLC (NPI 1154540540) is a healthcare organization registered as a physical therapist in Emory, Texas and active in the NPI registry since April 2007. The organization lists Paul Bacon, Licensed Physical Therapist, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
- Diagnose and manage movement dysfunction and enhance physical and functional abilities.
- Restore, maintain, and promote not only optimal physical function but optimal wellness and fitness and optimal quality of life as it relates to movement and health.
- Prevent the onset, symptoms, and progression of impairments, functional limitations, and disabilities that may result from diseases, disorders, conditions, or injuries.
- Treat conditions of the musculoskeletal, neuromuscular, cardiovascular, pulmonary, and/or integumentary systems.
- Address the negative effects attributable to unique personal and environmental factors as they relate to human performance.
Other Identifiers 1
Group Practice 1
Medicare Participation & PECOS CMS
Medicare enrollment, revalidation and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Lake Fork Physical Therapy, Pllc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Revalidation Due Date
Revalidation due by January 31, 2027
Medicare-enrolled providers and suppliers confirm their enrollment information with CMS on a set cycle, every 5 years for most and every 3 years for medical equipment suppliers. CMS sets the due date for each enrollment.
Clinicians Billing Medicare Through This Organization
Medicare enrollment records show 1 clinician reassigns Medicare billing to Lake Fork Physical Therapy, PLLC, which bills Medicare for the services this clinician delivers.
Clinician (1)
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Lake Fork Physical Therapy, PLLC's NPI number?
The NPI number for Lake Fork Physical Therapy, PLLC is 1154540540. It was assigned to this organization in the NPPES registry on April 24, 2007.
Where is Lake Fork Physical Therapy, PLLC located?
Lake Fork Physical Therapy, PLLC is located at 903 East Lennon Street Suite 101, Emory, TX 75440. The listed phone number is (903) 474-9436.
What is Lake Fork Physical Therapy, PLLC's specialty?
The primary specialty registered for this NPI is Physical Therapist with taxonomy code 225100000X.
Is Lake Fork Physical Therapy, PLLC enrolled in Medicare?
Yes. Lake Fork Physical Therapy, PLLC is registered in the Medicare PECOS enrollment system.
When is Lake Fork Physical Therapy, PLLC's Medicare revalidation due?
According to the CMS Revalidation Due Date List (October 2026 release), the Medicare Non-DME Part B enrollment for this organization (Texas, Physical/Occupational Therapy Group in Private Practice) is due for revalidation by January 31, 2027. Medicare providers and suppliers revalidate their enrollment every 5 years, and medical equipment suppliers every 3 years. Confirm current requirements with your Medicare Administrative Contractor.
How many clinicians bill Medicare through Lake Fork Physical Therapy, PLLC?
According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Physical Therapist in Private Practice) reassigns their Medicare billing to Lake Fork Physical Therapy, PLLC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
When was this NPI record last updated?
The NPPES record for Lake Fork Physical Therapy, PLLC was last updated on July 8, 2014. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 12 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Lake Fork Physical Therapy, Pllc · NPI 1154540540
Physical Therapist organization in Emory, Texas. Organization record, active in the CMS NPPES registry since April 24, 2007.
## Identity
- **NPI:** 1154540540 (Entity type: Organization)
- **Enumerated:** April 24, 2007
- **Primary specialty:** Physical Therapist · taxonomy 225100000X
- **Organization subpart:** No
- **Authorized official:** Paul Bacon, LICENSED PHYSICAL THERAPIST
## Practice location
- **Address:** 903 EAST LENNON STREET, SUITE 101, Emory, TX 75440
- **Phone:** (903) 474-9436
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Medicare revalidation due:** January 31, 2027 (Non-DME Part B, Texas, Physical/Occupational Therapy Group in Private Practice) · CMS Revalidation Due Date List, October 2026 release
- **Clinicians billing through this organization:** 1 clinician (Physical Therapist in Private Practice) reassigns Medicare billing to this organization (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** July 8, 2014
- **Other identifiers:** Other 00X464 (TX)
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Source: [NPI Profile](https://npiprofile.com/npi/1154540540) · Data from the CMS NPPES public registry.