Daryl Fajardo

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

CP025952T Issued in OH

Practice address

7819 Waynetowne Blvd
Huber Heights, OH 45424-2063

Phone

(937) 938-1583

NPI assigned

Nov 6, 2023

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

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.

• Ivyrehab Sept, LLC

  • Physical Medicine & Rehabilitation Physician
  • Verona, VA
  • NPI 1235955709

  Physical Therapist

  NPD
• Ivyrehab Sept, LLC

  • Physical Therapist
  • Virginia Beach, VA
  • NPI 1982657433
  NPD

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

{
    "created_epoch": "1699228800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719187200000",
    "number": "1245003706",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16331 FAIRFIELD LN",
            "city": "GRANGER",
            "state": "IN",
            "postal_code": "465309572",
            "telephone_number": "269-815-2419"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7819 WAYNETOWNE BLVD",
            "city": "HUBER HEIGHTS",
            "state": "OH",
            "postal_code": "454242063",
            "telephone_number": "937-938-1583"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "12610 Patrick Henry Dr Ste H",
            "address_purpose": "LOCATION",
            "city": "Newport News",
            "state": "VA",
            "postal_code": "236029538",
            "country_code": "US",
            "telephone_number": "757-874-1470",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FAJARDO",
        "first_name": "DARYL",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-11-06",
        "last_updated": "2024-06-24",
        "certification_date": "2024-06-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IN",
            "license": "05014807A",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "VA",
            "license": "CP032188T",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "OH",
            "license": "CP025952T",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Susanna Everhart, APRN, CNP
• Exceptional Quality Home Care LLC
• Extra Hands Care Home Healthcare LLC
• Josehine Imediegwu Eziolisa
• Jessica Fairchild, RBT
• Family Physicians of Huber Heights
• Family Physicians of Huber Heights
• Far Oaks Orthopedists, Inc
• Megan Farenwald
• Dzhamilya Fazilova

• Physical Therapist in Huber Heights, OH
• Providers in Huber Heights, OH by specialty
• Physical Therapist in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2024; 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.