Provider Demographics
NPI:1598750176
Name:LANDON, RICHARD CHARLES (MSPT)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:CHARLES
Last Name:LANDON
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1812 MARSH RD
Practice Address - Street 2:STORE 505
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19810-4581
Practice Address - Country:US
Practice Address - Phone:302-475-7500
Practice Address - Fax:302-475-5787
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2012-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT015816225100000X
DEJ1-0002838225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PALA1413014OtherBCBS
PAP01089025OtherMEDICARE RAILROAD
DE240311Y0XMedicare PIN
PAP01089025OtherMEDICARE RAILROAD