Basic Information
| Provider Information | |||||||||
| NPI: | 1659502763 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROOP | ||||||||
| FirstName: | KATRINA | ||||||||
| MiddleName: | MARIE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 855 MONTGOMERY ST | ||||||||
| Address2: | |||||||||
| City: | FORT WORTH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 761072553 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8177352228 | ||||||||
| FaxNumber: | 8177352582 | ||||||||
| Practice Location | |||||||||
| Address1: | 855 MONTGOMERY ST | ||||||||
| Address2: | |||||||||
| City: | FORT WORTH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 761072553 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8177352228 | ||||||||
| FaxNumber: | 8177352582 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/06/2009 | ||||||||
| LastUpdateDate: | 06/21/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 06/21/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 204D00000X | P6712 | TX | N | Allopathic & Osteopathic Physicians | Neuromusculoskeletal Medicine & OMM | 207Q00000X | OS10510 | FL | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | P6712 | TX | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 331456902 | 01 | TX | MEDICAID - OTHER COUNTY | OTHER | 339886YL7A | 01 | TX | MEDICARE - OTHER COUNTY | OTHER | 331456901 | 05 | TX | MEDICAID | P01427305 | 01 | TX | RAILROAD MEDICARE PTAN | OTHER |