Provider Demographics
NPI:1063676922
Name:LANDE, CHARESE RENE (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:MRS
First Name:CHARESE
Middle Name:RENE
Last Name:LANDE
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:7905 MESA TRAILS CIRCLE
Mailing Address - Street 2:HEALTHCARE
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-1730
Mailing Address - Country:US
Mailing Address - Phone:512-769-8464
Mailing Address - Fax:
Practice Address - Street 1:7905 MESA TRAILS CIR
Practice Address - Street 2:HEALTHCARE
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-1446
Practice Address - Country:US
Practice Address - Phone:512-769-8464
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-10
Last Update Date:2016-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1037026225100000X
TXMT025709225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist