Provider Demographics
NPI:1467666255
Name:LANDON, LISA (PTA)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:
Last Name:LANDON
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 REYNOLDS AVE
Mailing Address - Street 2:
Mailing Address - City:NATICK
Mailing Address - State:MA
Mailing Address - Zip Code:01760-4857
Mailing Address - Country:US
Mailing Address - Phone:508-653-2577
Mailing Address - Fax:
Practice Address - Street 1:10 REYNOLDS AVE
Practice Address - Street 2:
Practice Address - City:NATICK
Practice Address - State:MA
Practice Address - Zip Code:01760-4857
Practice Address - Country:US
Practice Address - Phone:508-653-2577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3647225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant