Provider Demographics
NPI:1922744762
Name:LANDIS, PAYTON C
Entity Type:Individual
Prefix:
First Name:PAYTON
Middle Name:C
Last Name:LANDIS
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 1:2857 AMBERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:OH
Mailing Address - Zip Code:45373-7602
Mailing Address - Country:US
Mailing Address - Phone:937-825-2455
Mailing Address - Fax:
Practice Address - Street 1:2857 AMBERWOOD DR
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:OH
Practice Address - Zip Code:45373-7602
Practice Address - Country:US
Practice Address - Phone:937-825-2455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-05
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide