Provider Demographics
NPI:1770079030
Name:LAND, THOMAS (PT, DPT)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:LAND
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:248 COUNTRY CLUB PKWY
Mailing Address - Street 2:
Mailing Address - City:SPRING CREEK
Mailing Address - State:NV
Mailing Address - Zip Code:89815-5830
Mailing Address - Country:US
Mailing Address - Phone:775-777-1276
Mailing Address - Fax:775-777-7022
Practice Address - Street 1:617 MAIN STREET
Practice Address - Street 2:
Practice Address - City:CARLIN
Practice Address - State:NV
Practice Address - Zip Code:89822
Practice Address - Country:US
Practice Address - Phone:775-777-1276
Practice Address - Fax:775-777-7022
Is Sole Proprietor?:No
Enumeration Date:2018-07-10
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
NV4663225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist