Provider Demographics
NPI:1497361604
Name:VANLANDINGHAM, MICHAEL
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:
Last Name:VANLANDINGHAM
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:MIKE
Other - Middle Name:
Other - Last Name:VANLANDINGHAM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:11083 HAMILTON AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45231-1409
Mailing Address - Country:US
Mailing Address - Phone:513-674-4200
Mailing Address - Fax:513-742-8339
Practice Address - Street 1:11083 HAMILTON AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45231-1409
Practice Address - Country:US
Practice Address - Phone:513-674-4200
Practice Address - Fax:513-742-8339
Is Sole Proprietor?:No
Enumeration Date:2020-09-22
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT0034782251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics