Provider Demographics
NPI:1235437948
Name:LANDIS, WHITNEY A (PT, DPT)
Entity Type:Individual
Prefix:
First Name:WHITNEY
Middle Name:A
Last Name:LANDIS
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:WHITNEY
Other - Middle Name:A
Other - Last Name:MAYS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3959 RUFFIN RD STE J
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-1830
Mailing Address - Country:US
Mailing Address - Phone:858-279-5570
Mailing Address - Fax:858-279-5303
Practice Address - Street 1:3959 RUFFIN RD STE J
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-1830
Practice Address - Country:US
Practice Address - Phone:858-279-5570
Practice Address - Fax:858-279-5303
Is Sole Proprietor?:No
Enumeration Date:2011-03-03
Last Update Date:2018-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41789225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ146752OtherMEDICARE PTAN
CACB226503OtherMEDICARE