Individual provider Active NPI

Dillon Tabar

  • Physical Therapist
  • Port Orange, FL
National Provider Identifier
1073039665
Registry record updated Feb 29, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
2305211375 Issued in VA
Practice address
5535 S Williamson Blvd
Port Orange, FL 32128
Phone
(888) 265-2680
NPI assigned
Aug 16, 2017
Last updated
Feb 29, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 29, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 1306068 TX
Physical Therapist 225100000X 9047 SC
Physical Therapist 225100000X 2305211375 VA Primary

Addresses

Primary practice location

5535 S Williamson Blvd
Port Orange, FL 32128

Mailing address

790 Remington Blvd
Bolingbrook, IL 60440-4909

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210426000422 TX Practitioner - Physical Therapist in Private Practice 5092123406 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
85.56 of 100Reported as group
Quality
89.48
Improvement activities
40
Cost
71.16

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2305211375VAMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Ideal Physical Therapy of Texas LLC Physical Therapist CurrentSince Apr 26, 2021 Accepting new patients
Ideal Physical Therapy of Texas LLC CurrentSince Apr 26, 2021 Accepting new patients

Locations

790 Remington Blvd
Bolingbrook, IL 60440

17051 Dallas Pkwy
Ste 450
Addison, TX 75001
Phone (214) 272-8561

1827 SW Green Oaks Blvd
Ste 143
Arlington, TX 76017
Phone (512) 501-4783

5335 W Sublett Rd
Ste 151
Arlington, TX 76017
Phone (817) 839-9150

4100 Fairway Dr
Ste 400
Carrollton, TX 75010
Phone (972) 394-3325

379 E FM 1382
Ste 100
Cedar Hill, TX 75104
Phone (972) 460-4490

4843 Colleyville Blvd
Ste 221
Colleyville, TX 76034
Phone (817) 576-7520

607 S Cedar Ridge Dr
Unit 102
Duncanville, TX 75137
Phone (214) 742-8560

1540 Eastchase Pkwy
Ste 4A
Fort Worth, TX 76120

2600 W 7th St
Ste 137
Fort Worth, TX 76107
Phone (682) 233-6462

1215 W Pioneer Pkwy
Ste 200
Grand Prairie, TX 75051
Phone (972) 400-4752

2360 W Camp Wisdom Rd
Ste 140
Grand Prairie, TX 75052
Phone (469) 460-6683

3141 E Broad St
Ste 111
Mansfield, TX 76063
Phone (817) 435-5248

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1502841600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1709164800000",
    "number": "1073039665",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "790 REMINGTON BLVD",
            "city": "BOLINGBROOK",
            "state": "IL",
            "postal_code": "604404909"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5535 S WILLIAMSON BLVD",
            "city": "PORT ORANGE",
            "state": "FL",
            "postal_code": "32128",
            "telephone_number": "888-265-2680"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TABAR",
        "first_name": "DILLON",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-08-16",
        "last_updated": "2024-02-29",
        "certification_date": "2024-02-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "TX",
            "license": "1306068",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "SC",
            "license": "9047",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "VA",
            "license": "2305211375",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Orange, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 29, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.