Active NPI
Jareb C Landon, PT, DPT
- Physical Therapist
- Daytona Beach, FL
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT-34078
- Practice address
- 1865 Lpga Blvd
Daytona Beach, FL 32117-7108 - Phone
- (386) 255-4596
- Fax
- (386) 257-0558
- NPI assigned
- Mar 5, 2019
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Orthopedic Physical Therapist | 2251X0800X | PT-34078 | FL | |
| Physical Therapist | 225100000X | PT-34078 | FL | Primary |
| Pediatric Physical Therapist | 2251P0200X | PT6215 | ID |
Addresses
Primary practice location
1865 Lpga Blvd
Daytona Beach, FL 32117-7108
Mailing address
1865 Lpga Blvd
Daytona Beach, FL 32117-7108
Phone (386) 255-4596
Other practice location 1
1075 Mason Ave
Daytona Beach, FL 32117-4690
Phone (386) 255-4596
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 111170900 | Medicaid | FL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in FL
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Physical Therapist in Private Practice
- Education
- Other, 2018
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
17 Old Kings Rd N
Suite K
Palm Coast, FL 32137-8283
Phone (386) 255-4596
Merit-based Incentive Payment System (MIPS)
- Final score
- 75 of 100
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT6215 | ID | MD | Pediatric Physical Therapist |
| PT-34078 | FL | MD | Orthopedic Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Orthopaedic Clinic of Daytona Beach PA | Current | Accepting new patients | |
| Orthopaedic Clinic of Daytona Beach PA | Current | Accepting new patients | |
| Mountain View Hospital LLC | Past | Accepting new patients | |
| Speech and Language Clinic, Inc | Past | Accepting new patients |
Locations
1865 Lpga Blvd
Daytona Beach, FL 32117
Phone (386) 255-4596
1075 Mason Ave
Daytona Beach, FL 32117
Phone (386) 255-4596
1890 Lpga Blvd
Ste 240
Daytona Beach, FL 32117
Phone (386) 255-4596
17 Old Kings Rd N
Ste K
Palm Coast, FL 32137
Phone (386) 255-4596
1165 Dunlawton Ave
Ste 102
Port Orange, FL 32127
Phone (386) 255-4596
Interoperability endpoints
- https://api.platform.athenahealth.com/10735/brand/1/csg/1/fhir/r4
- jareb.landon.1@10735.direct.athenahealth.com
Organizations & group practices 4
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.
-
- Orthopaedic Surgery Physician
- Daytona Beach, FL
- NPI 1558340240
-
- Durable Medical Equipment & Medical Supplies
- Port Orange, FL
- NPI 1023678745
-
- General Acute Care Hospital
- Idaho Falls, ID
- NPI 1669462362
-
- Speech-Language Pathologist
- Ammon, ID
- NPI 1891953519
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1551744000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1732060800000",
"number": "1295293652",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1865 LPGA BLVD",
"city": "DAYTONA BEACH",
"state": "FL",
"postal_code": "321177108",
"telephone_number": "386-255-4596",
"fax_number": "386-257-0558"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1865 LPGA BLVD",
"city": "DAYTONA BEACH",
"state": "FL",
"postal_code": "321177108",
"telephone_number": "386-255-4596",
"fax_number": "386-257-0558"
}
],
"practiceLocations": [
{
"address_1": "1075 Mason Ave",
"address_purpose": "LOCATION",
"city": "Daytona Beach",
"state": "FL",
"postal_code": "321174690",
"country_code": "US",
"telephone_number": "386-255-4596",
"fax_number": "386-257-0558",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "LANDON",
"first_name": "JAREB",
"middle_name": "C",
"credential": "PT, DPT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-03-05",
"last_updated": "2024-11-20",
"certification_date": "2024-11-20",
"status": "A"
},
"taxonomies": [
{
"code": "2251X0800X",
"taxonomy_group": "",
"desc": "Physical Therapist, Orthopedic",
"state": "FL",
"license": "PT-34078",
"primary": false
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "FL",
"license": "PT-34078",
"primary": true
},
{
"code": "2251P0200X",
"taxonomy_group": "",
"desc": "Physical Therapist, Pediatrics",
"state": "ID",
"license": "PT6215",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "111170900",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Daytona Beach, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 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.