Provider Demographics
NPI:1124371398
Name:LANDY, BROOKS P (DPT)
Entity Type:Individual
Prefix:
First Name:BROOKS
Middle Name:P
Last Name:LANDY
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1705
Mailing Address - Street 2:
Mailing Address - City:CODY
Mailing Address - State:WY
Mailing Address - Zip Code:82414-1705
Mailing Address - Country:US
Mailing Address - Phone:307-587-9866
Mailing Address - Fax:307-587-9867
Practice Address - Street 1:75 JONES AND GIFFORD AVE
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:NY
Practice Address - Zip Code:14701-2828
Practice Address - Country:US
Practice Address - Phone:716-661-1541
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-24
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP86170225100000X
FLPT28647225100000X
NY035860225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist