Provider Demographics
NPI:1932136975
Name:LANDRY, RYAN JAMES (LAT)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:JAMES
Last Name:LANDRY
Suffix:
Gender:M
Credentials:LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:167 E OAKLAND ST
Mailing Address - Street 2:
Mailing Address - City:ST ROSE
Mailing Address - State:LA
Mailing Address - Zip Code:70087-3231
Mailing Address - Country:US
Mailing Address - Phone:504-430-2364
Mailing Address - Fax:
Practice Address - Street 1:167 E OAKLAND ST
Practice Address - Street 2:
Practice Address - City:ST ROSE
Practice Address - State:LA
Practice Address - Zip Code:70087-3231
Practice Address - Country:US
Practice Address - Phone:504-430-2364
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer