Provider Demographics
NPI:1518255637
Name:LANDRY, MICHELLE L (PT, DPT)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:L
Last Name:LANDRY
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:MS
Other - First Name:MICHELLE
Other - Middle Name:L
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:530 SHADOWS LN
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-6530
Mailing Address - Country:US
Mailing Address - Phone:225-231-3800
Mailing Address - Fax:225-231-3803
Practice Address - Street 1:530 SHADOWS LN
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-6530
Practice Address - Country:US
Practice Address - Phone:225-231-3800
Practice Address - Fax:225-231-3803
Is Sole Proprietor?:No
Enumeration Date:2011-07-11
Last Update Date:2016-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA08120225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist