Provider Demographics
NPI:1538299177
Name:LANDRUS, REGINA M (PT)
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:M
Last Name:LANDRUS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 ROY ST
Mailing Address - Street 2:
Mailing Address - City:ORTONVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:56278-1138
Mailing Address - Country:US
Mailing Address - Phone:320-839-4271
Mailing Address - Fax:320-839-4196
Practice Address - Street 1:1420 E COLLEGE DR
Practice Address - Street 2:SUITE 704
Practice Address - City:MARSHALL
Practice Address - State:MN
Practice Address - Zip Code:56258-2065
Practice Address - Country:US
Practice Address - Phone:507-532-3393
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2010-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5904225100000X
SD1241225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN650001770Medicare PIN
MN650001769Medicare PIN