Provider Demographics
NPI:1427184985
Name:LANDRUM, STEFFANY (PT, DPT)
Entity Type:Individual
Prefix:PROF
First Name:STEFFANY
Middle Name:
Last Name:LANDRUM
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:807 KAMAK DR
Mailing Address - Street 2:
Mailing Address - City:BEEBE
Mailing Address - State:AR
Mailing Address - Zip Code:72012-2087
Mailing Address - Country:US
Mailing Address - Phone:501-258-7944
Mailing Address - Fax:
Practice Address - Street 1:710 W DEWITT HENRY DR STE D
Practice Address - Street 2:
Practice Address - City:BEEBE
Practice Address - State:AR
Practice Address - Zip Code:72012-2102
Practice Address - Country:US
Practice Address - Phone:501-882-2260
Practice Address - Fax:501-882-2369
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2014-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT2924225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR161890721Medicaid