Landen Brock, PT, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PTO16664 Issued in GA

Practice address

2138 Dillard Xing
Tucker, GA 30084-5878

Phone

(205) 480-4466

NPI assigned

Jun 27, 2023

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

Enrolled in AL

Enrollment records 1

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.

• Agile Physical Therapy, LLC

  • Physical Therapy Clinic/Center
  • Vestavia, AL
  • NPI 1154578524
  Medicare reassignment NPD

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

{
    "created_epoch": "1687824000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1687824000000",
    "number": "1356027973",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2138 DILLARD XING",
            "city": "TUCKER",
            "state": "GA",
            "postal_code": "300845878",
            "telephone_number": "205-480-4466"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2138 DILLARD XING",
            "city": "TUCKER",
            "state": "GA",
            "postal_code": "300845878",
            "telephone_number": "205-480-4466"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROCK",
        "first_name": "LANDEN",
        "credential": "PT, DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-06-27",
        "last_updated": "2023-06-27",
        "certification_date": "2023-06-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "GA",
            "license": "PTO16664",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mary J Brennan, OT
• Briarwood Health Center by Harborview, LLC
• Briarwood Operating Company LLC
• Alexander Brikman, PSY.D.
• Brittany Robinson PHD & Associates, LLC
• Susan C Brogan, CCC-SLP
• Brooke Gently Hargrove LLC
• Kyshia Brooks, LCAS/OWNER
• Dana Brown, SLP
• Diana Brown

• Physical Therapist in Tucker, GA
• Providers in Tucker, GA by specialty
• Physical Therapist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.