Individual provider Active NPI

Jennifer A Lutzyk, PT

  • Physical Therapist
  • Daytona Beach, FL
National Provider Identifier
1366535551
Registry record updated Aug 15, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT15389 Issued in FL
Practice address
1075 Mason Ave
Daytona Beach, FL 32117
Phone
(386) 255-4596
Fax
(386) 258-3561
NPI assigned
Oct 2, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 15, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopedic Physical Therapist 2251X0800X PT15389 FL
Physical Therapist 225100000X PT15389 FL Primary

Addresses

Primary practice location

1075 Mason Ave
Daytona Beach, FL 32117

Mailing address

1075 Mason Ave
Daytona Beach, FL 32117-4611
Phone (386) 255-4596

Other practice location 1

17 Old Kings Rd N Ste K
Palm Coast, FL 32137-8283
Phone (386) 255-4596

Other practice location 2

1165 Dunlawton Ave Ste 102
Port Orange, FL 32127-2924
Phone (386) 255-4596

Other practice location 3

1890 Lpga Blvd Ste 240
Daytona Beach, FL 32117-7131
Phone (386) 255-4596

Other names 1

  • Jennifer A Perkins Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040831000949 FL Practitioner - Physical Therapist in Private Practice 8022083294 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
New Smyrna Beach Physical Therapy, LLCGroup PAC ID 4789082686, 2 clinicians

Practice addresses (Care Compare)

701 E 3Rd Ave
Unit 6
New Smyrna Beach, FL 32169-3104
Phone (386) 957-3902

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
New Smyrna Beach Physical Therapy LLC Physical Therapist CurrentSince Feb 5, 2024 Accepting new patients
Blue Water Therapy Inc Physical Therapist CurrentSince Sep 13, 2021 Accepting new patients
Baseline Rehabilitation Inc Past Accepting new patients
Merrimack Valley Physical Therapy Physical Therapist PastSince Jun 1, 2002 Accepting new patients
Performance Rehab, Inc. Physical Therapist PastSince Apr 28, 1999 Accepting new patients

Locations

701 E 3rd Ave
Ste 6
New Smyrna Beach, FL 32169
Phone (386) 597-3992

916 N Dixie Fwy
New Smyrna Beach, FL 32168
Phone (386) 426-7885

Networks

  • Freedom Health HMO Network

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1159747200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1534291200000",
    "number": "1366535551",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1075 MASON AVE",
            "city": "DAYTONA BEACH",
            "state": "FL",
            "postal_code": "321174611",
            "telephone_number": "386-255-4596",
            "fax_number": "386-258-3561"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1075 MASON AVE",
            "city": "DAYTONA BEACH",
            "state": "FL",
            "postal_code": "32117",
            "telephone_number": "386-255-4596",
            "fax_number": "386-258-3561"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "17 Old Kings Rd N Ste K",
            "address_purpose": "LOCATION",
            "city": "Palm Coast",
            "state": "FL",
            "postal_code": "321378283",
            "country_code": "US",
            "telephone_number": "386-255-4596",
            "fax_number": "386-258-3561",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1165 Dunlawton Ave Ste 102",
            "address_purpose": "LOCATION",
            "city": "Port Orange",
            "state": "FL",
            "postal_code": "321272924",
            "country_code": "US",
            "telephone_number": "386-255-4596",
            "fax_number": "386-258-3561",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1890 Lpga Blvd Ste 240",
            "address_purpose": "LOCATION",
            "city": "Daytona Beach",
            "state": "FL",
            "postal_code": "321177131",
            "country_code": "US",
            "telephone_number": "386-255-4596",
            "fax_number": "386-258-3561",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LUTZYK",
        "first_name": "JENNIFER",
        "middle_name": "A",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-02",
        "last_updated": "2018-08-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2251X0800X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Orthopedic",
            "state": "FL",
            "license": "PT15389",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "FL",
            "license": "PT15389",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JENNIFER",
            "last_name": "PERKINS",
            "middle_name": "A",
            "credential": "PT",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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 Aug 15, 2018; 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.

Verify at the official NPI Registry.