Provider Demographics
NPI:1083922355
Name:MCDILL, LANDON L (CPTA)
Entity Type:Individual
Prefix:
First Name:LANDON
Middle Name:L
Last Name:MCDILL
Suffix:
Gender:M
Credentials:CPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:723 N HIGH ST
Mailing Address - Street 2:
Mailing Address - City:MANKATO
Mailing Address - State:KS
Mailing Address - Zip Code:66956-1507
Mailing Address - Country:US
Mailing Address - Phone:785-378-8045
Mailing Address - Fax:
Practice Address - Street 1:620 2ND AVE
Practice Address - Street 2:
Practice Address - City:CONCORDIA
Practice Address - State:KS
Practice Address - Zip Code:66901-2727
Practice Address - Country:US
Practice Address - Phone:785-243-2720
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-20
Last Update Date:2010-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS14-01675225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant