Provider Demographics
NPI:1932645850
Name:LANDRUM, MAKAYLA (MS,LAT,ATC,CISSN)
Entity Type:Individual
Prefix:
First Name:MAKAYLA
Middle Name:
Last Name:LANDRUM
Suffix:
Gender:F
Credentials:MS,LAT,ATC,CISSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:503 THOMPSON ST
Mailing Address - Street 2:
Mailing Address - City:GAFFNEY
Mailing Address - State:SC
Mailing Address - Zip Code:29340-3619
Mailing Address - Country:US
Mailing Address - Phone:248-259-6828
Mailing Address - Fax:
Practice Address - Street 1:503 THOMPSON ST
Practice Address - Street 2:
Practice Address - City:GAFFNEY
Practice Address - State:SC
Practice Address - Zip Code:29340-3619
Practice Address - Country:US
Practice Address - Phone:248-259-6828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-17
Last Update Date:2020-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA0935782255A2300X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty