Provider Demographics
NPI:1457470023
Name:LANDRUM, LORI ANNE (PT, DPT)
Entity Type:Individual
Prefix:MRS
First Name:LORI
Middle Name:ANNE
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 1:43 LANDRUM RD
Mailing Address - Street 2:
Mailing Address - City:OVETT
Mailing Address - State:MS
Mailing Address - Zip Code:39464-3735
Mailing Address - Country:US
Mailing Address - Phone:601-319-5304
Mailing Address - Fax:
Practice Address - Street 1:204 N 15TH AVE
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MS
Practice Address - Zip Code:39440-4122
Practice Address - Country:US
Practice Address - Phone:601-342-2344
Practice Address - Fax:601-342-2344
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2017-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT1798225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist