Provider Demographics
NPI:1700432382
Name:LANDERS, JEANETTE MARIE (PTA)
Entity Type:Individual
Prefix:
First Name:JEANETTE
Middle Name:MARIE
Last Name:LANDERS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 SHARON ST
Mailing Address - Street 2:
Mailing Address - City:BATESVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72501-5328
Mailing Address - Country:US
Mailing Address - Phone:870-834-8461
Mailing Address - Fax:
Practice Address - Street 1:212 SHARON ST
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:AR
Practice Address - Zip Code:72501-5328
Practice Address - Country:US
Practice Address - Phone:870-834-8461
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-10
Last Update Date:2019-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPTA1907225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant