Colleena Lynn Landis – Physical Therapy Assistant

Key facts

NPI: 1306560784
Entity type: Individual (NPI type 1)
Primary specialty: Physical Therapy Assistant 225200000X
License: 002778 (WV)
Practice address: 100 Hospital Dr Ste 3
Petersburg, WV 26847-9570
Phone: (304) 257-1015
Fax: (304) 257-1129
NPI assigned: Sep 29, 2022
Sex: Female
Sole proprietor: No

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 and National Provider Directory roles.

Grant Memorial Homecare and Hospice LLC Home Health Agency · Petersburg, WV · NPI 1104084151

NPD
Grant Memorial Homecare and Hospice, LLC Community Based Hospice Care Agency · Petersburg, WV · NPI 1053579102

NPD (past)

Medicare participation

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD): No

State licenses

License	State	Type	Specialty
002778	WV	MD	Physical Therapy Assistant

Practice roles

Organization	Specialty	Status	New patients
Grant Memorial Homecare and Hospice LLC		Current since Oct 2, 2022	Accepting new patients
Grant Memorial Homecare and Hospice, LLC		Past since Oct 2, 2022	Accepting new patients

Locations

100 Hospital Dr
Ste 3
Petersburg, WV 26847
Phone (304) 257-1015

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Physical Therapy Assistant	225200000X	002778	WV	Yes

Addresses

Primary practice location

100 Hospital Dr Ste 3
Petersburg, WV 26847-9570

Mailing address

880 Grizzly Rd
Maysville, WV 26833-8736
Phone (304) 813-3991

Electronic endpoints

Type	Endpoint	Use	Affiliation
CONNECT URL	Desktop/Tablet

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Sep 29, 2022.

{
    "created_epoch": "1664409600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1664409600000",
    "number": "1306560784",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "880 GRIZZLY RD",
            "city": "MAYSVILLE",
            "state": "WV",
            "postal_code": "268338736",
            "telephone_number": "304-813-3991"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 HOSPITAL DR STE 3",
            "city": "PETERSBURG",
            "state": "WV",
            "postal_code": "268479570",
            "telephone_number": "304-257-1015",
            "fax_number": "304-257-1129"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LANDIS",
        "first_name": "COLLEENA",
        "middle_name": "LYNN",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-09-29",
        "last_updated": "2022-09-29",
        "certification_date": "2022-09-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "WV",
            "license": "002778",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Desktop/Tablet",
            "affiliation": "N",
            "address_1": "100 Hospital Dr Ste 3",
            "city": "Petersburg",
            "state": "WV",
            "country_code": "US",
            "postal_code": "268479570",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Petersburg, WV

All providers in Petersburg, WV · Physical Therapy Assistant in West Virginia

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 29, 2022. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.