Provider Demographics
NPI:1669524195
Name:LANDERS PHYSICAL THERAPY SERVICES, LLC
Entity type:Organization
Organization Name:LANDERS PHYSICAL THERAPY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF PHYSICAL THERAPY
Authorized Official - Prefix:DR
Authorized Official - First Name:P.J.
Authorized Official - Middle Name:
Authorized Official - Last Name:LANDERS
Authorized Official - Suffix:
Authorized Official - Credentials:DPT, MTC, OCS
Authorized Official - Phone:985-809-9088
Mailing Address - Street 1:1010 S POLK ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-2474
Mailing Address - Country:US
Mailing Address - Phone:985-809-9088
Mailing Address - Fax:985-809-9270
Practice Address - Street 1:1010 S POLK ST
Practice Address - Street 2:SUITE 2
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-2474
Practice Address - Country:US
Practice Address - Phone:985-809-9088
Practice Address - Fax:985-809-9270
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2007-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPT04633225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5CK10Medicare PIN