Provider Demographics
NPI:1275563371
Name:LANDON, TIMOTHY D (PT)
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:D
Last Name:LANDON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22621 NORTHWOODS DR
Mailing Address - Street 2:
Mailing Address - City:CHUGIAK
Mailing Address - State:AK
Mailing Address - Zip Code:99567-5459
Mailing Address - Country:US
Mailing Address - Phone:907-746-7300
Mailing Address - Fax:907-746-7302
Practice Address - Street 1:7335 E PALMER-WASILLA HIGHWAY
Practice Address - Street 2:SUITE C
Practice Address - City:PALMER
Practice Address - State:AK
Practice Address - Zip Code:99645
Practice Address - Country:US
Practice Address - Phone:907-746-7300
Practice Address - Fax:907-746-7302
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKPT1054225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKPT1054Medicaid