Provider Demographics
NPI:1417174251
Name:LANDRY, MEREDITH J (PT)
Entity Type:Individual
Prefix:
First Name:MEREDITH
Middle Name:J
Last Name:LANDRY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MEREDITH
Other - Middle Name:BINTLIFF
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:5908 WAYMAKER CV
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78746-1855
Mailing Address - Country:US
Mailing Address - Phone:512-347-0372
Mailing Address - Fax:
Practice Address - Street 1:4310 JAMES CASEY ST
Practice Address - Street 2:STE. 1-D
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-1120
Practice Address - Country:US
Practice Address - Phone:512-445-5213
Practice Address - Fax:512-445-4353
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1042760225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8G0751Medicare ID - Type Unspecified