Jedidiah Lagos Tan, RPT, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

1342184 Issued in TX

Practice address

4102 Veterans Dr
Pearland, TX 77584-2950

Phone

(832) 379-0668

NPI assigned

Apr 6, 2021

Reactivated

May 9, 2022

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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

• Fixio Physical Therapy & Recovery Clinic

  • Physical Therapist
  • Pearland, TX
  • NPI 1861141749
  NPD Authorized official

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

{
    "created_epoch": "1617667200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1659052800000",
    "number": "1114506110",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12602 CARLISLE FALLS CT",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770891594",
            "telephone_number": "832-379-0668"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4102 VETERANS DR",
            "city": "PEARLAND",
            "state": "TX",
            "postal_code": "775842950",
            "telephone_number": "832-379-0668"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TAN",
        "first_name": "JEDIDIAH",
        "middle_name": "LAGOS",
        "credential": "RPT, DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-04-06",
        "last_updated": "2022-07-29",
        "certification_date": "2022-07-29",
        "deactivation_date": "2022-03-19",
        "reactivation_date": "2022-05-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "TX",
            "license": "1342184",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Komal Talati, M.D.
• Brian Talbot, M.D.
• Savannah Tamayo
• Jeannine Paola Tamez, PHD
• Ellen W Tan, OTR, MOT
• Chau Tang
• Marta Tang
• Nancy Yimfong Tang, NP-C, FNP, APRN
• Alexis Nicole Tarr, LCSW
• Robin Tatem

• Physical Therapist in Pearland, TX
• Providers in Pearland, TX by specialty
• Physical Therapist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.