Provider Demographics
NPI:1134909484
Name:LANDIS, EMILEE (DPT)
Entity type:Individual
Prefix:
First Name:EMILEE
Middle Name:
Last Name:LANDIS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2668 E CITIZENS DR STE 5
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-4796
Mailing Address - Country:US
Mailing Address - Phone:479-442-7473
Mailing Address - Fax:
Practice Address - Street 1:1188 N SALEM RD STE 1
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72704-8807
Practice Address - Country:US
Practice Address - Phone:479-442-7473
Practice Address - Fax:479-239-5444
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-04
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist