Provider Demographics
NPI:1639362866
Name:LANDRUS, ELIZABETH (PT)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:
Last Name:LANDRUS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:ELIZABETH
Other - Middle Name:CORRIGAN
Other - Last Name:LANDRUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:119 BAKERS ACRES DR
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:FL
Mailing Address - Zip Code:32640-4159
Mailing Address - Country:US
Mailing Address - Phone:352-234-5777
Mailing Address - Fax:
Practice Address - Street 1:119 BAKERS ACRES DR
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:FL
Practice Address - Zip Code:32640-4159
Practice Address - Country:US
Practice Address - Phone:352-234-5777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-21
Last Update Date:2020-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT4639174400000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty