Provider Demographics
NPI:1942539267
Name:LANDINGIN, EUGENE RYAN REYES (PT)
Entity Type:Individual
Prefix:MR
First Name:EUGENE RYAN
Middle Name:REYES
Last Name:LANDINGIN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1616 HAMILTON ST
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07109-5346
Mailing Address - Country:US
Mailing Address - Phone:630-398-1430
Mailing Address - Fax:205-520-0455
Practice Address - Street 1:1616 HAMILTON ST
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07109-5346
Practice Address - Country:US
Practice Address - Phone:630-398-1430
Practice Address - Fax:205-520-0455
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-15
Last Update Date:2019-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070017123225100000X
NY9701978225100000X
NJ40QA01371300225100000X
CT008642225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist