Provider Demographics
NPI:1013343862
Name:LANDIS, SEAN PATRICK (DPT)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:PATRICK
Last Name:LANDIS
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9051 TAMIAMI TRL N
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34108-2596
Mailing Address - Country:US
Mailing Address - Phone:239-591-4711
Mailing Address - Fax:
Practice Address - Street 1:9051 TAMIAMI TRL N
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34108-2596
Practice Address - Country:US
Practice Address - Phone:239-591-4711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-24
Last Update Date:2017-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL28611225100000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL28611OtherFLORIDA BOARD OF PHYSICAL THERAPY PRACTICE
LA08703ROtherLOUISIANA BOARD OF PHYSICAL THERAPY PRACTICE