Active NPI
Andrew Jerard Landis, PTA
- Physical Therapy Assistant
- Roseville, CA
National Provider Identifier
1639949670
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 52944
- Practice address
- 568 N Sunrise Ave Ste 110
Roseville, CA 95661-3097 - Phone
- (916) 865-1100
- NPI assigned
- Jan 2, 2024
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | 52944 | CA | Primary |
Addresses
Primary practice location
568 N Sunrise Ave Ste 110
Roseville, CA 95661-3097
Mailing address
1675 Vernon St Unit 58
Roseville, CA 95678-3968
Phone (530) 604-1311
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 52944 | CA | MD | Medical Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1704153600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1704153600000",
"number": "1639949670",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1675 VERNON ST UNIT 58",
"city": "ROSEVILLE",
"state": "CA",
"postal_code": "956783968",
"telephone_number": "530-604-1311"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "568 N SUNRISE AVE STE 110",
"city": "ROSEVILLE",
"state": "CA",
"postal_code": "956613097",
"telephone_number": "916-865-1100"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LANDIS",
"first_name": "ANDREW",
"middle_name": "JERARD",
"credential": "PTA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2024-01-02",
"last_updated": "2024-01-02",
"certification_date": "2024-01-02",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "CA",
"license": "52944",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Roseville, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 2, 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.