MEDICARE: JACOB LANDIS PT, DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1437007614
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACOB LANDIS PT, DPT

Provider Business Mailing Address
First Line	:	1429 BRYANT ST STE A
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28208-5201
Country	:	US
Telephone Number	:	704-919-0867
Fax Number	:	704-817-8579

Provider Business Practice Location Address
First Line	:	1001 VAN BUREN AVE STE 3
Second Line	:
City	:	INDIAN TRAIL
State	:	NC
Zip	:	28079-5541
Country	:	US
Telephone Number	:	704-628-6053
Fax Number	:	704-628-6702

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/21/2026
Last Update Date	:	03/21/2026

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