Provider Demographics
NPI:1588020895
Name:LANDRY, THERESA
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:
Last Name:LANDRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19184 DR JOHN LAMBERT DR
Mailing Address - Street 2:STE 104
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70403-0935
Mailing Address - Country:US
Mailing Address - Phone:985-542-7150
Mailing Address - Fax:985-542-7155
Practice Address - Street 1:19184 DR JOHN LAMBERT DR
Practice Address - Street 2:STE 104
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-0935
Practice Address - Country:US
Practice Address - Phone:985-542-7150
Practice Address - Fax:985-542-7155
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-04
Last Update Date:2016-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies