David Jantz, LAT, ATC, PES, CES

Primary specialty

Sports Medicine (Physical Medicine & Rehabilitation) PhysicianTaxonomy code 2081S0010X

License

AL3484 Issued in FL

Practice address

13895 Hwy 27
Lake Wales, FL 33859-2549

Phone

(863) 368-7567

NPI assigned

Jul 8, 2017

Sex

Male

Sole proprietor

Yes

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1499472000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1499472000000",
    "number": "1679095954",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13895 HIGHWAY 27",
            "city": "LAKE WALES",
            "state": "FL",
            "postal_code": "33859"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13895 HWY 27",
            "city": "LAKE WALES",
            "state": "FL",
            "postal_code": "338592549",
            "telephone_number": "863-368-7567"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JANTZ",
        "first_name": "DAVID",
        "credential": "LAT, ATC, PES, CES",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-07-08",
        "last_updated": "2017-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2081S0010X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation, Sports Medicine",
            "state": "FL",
            "license": "AL3484",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Sports Medicine (Physical Medicine & Rehabilitation) Physician in Lake Wales, FL
• Providers in Lake Wales, FL by specialty
• Sports Medicine (Physical Medicine & Rehabilitation) Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.