Provider Demographics
NPI:1437259280
Name:LANDERS, TERRANCE N (CPED)
Entity Type:Individual
Prefix:MR
First Name:TERRANCE
Middle Name:N
Last Name:LANDERS
Suffix:
Gender:M
Credentials:CPED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1825 PARADISE RD
Mailing Address - Street 2:UNIT 502
Mailing Address - City:ORRVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44667-9421
Mailing Address - Country:US
Mailing Address - Phone:330-642-0227
Mailing Address - Fax:330-642-0227
Practice Address - Street 1:1825 PARADISE RD
Practice Address - Street 2:UNIT 502
Practice Address - City:ORRVILLE
Practice Address - State:OH
Practice Address - Zip Code:44667-9421
Practice Address - Country:US
Practice Address - Phone:330-642-0227
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH270-6807Medicaid
OH5927400001Medicare NSC