1689670788 NPI number — DR. P.J. LANDERS D.P.T., M.T.C.

Table of content: DR. P.J. LANDERS D.P.T., M.T.C. (NPI 1689670788)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689670788 NPI number — DR. P.J. LANDERS D.P.T., M.T.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LANDERS
Provider First Name:
P.J.
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.P.T., M.T.C.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1689670788
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/08/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1010 S POLK ST
Provider Second Line Business Mailing Address:
STE 2
Provider Business Mailing Address City Name:
COVINGTON
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70433-2474
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
985-809-9088
Provider Business Mailing Address Fax Number:
985-809-9270

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1010 S POLK ST
Provider Second Line Business Practice Location Address:
STE 2
Provider Business Practice Location Address City Name:
COVINGTON
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70433-2474
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
985-809-9088
Provider Business Practice Location Address Fax Number:
985-809-9270
Provider Enumeration Date:
06/23/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  P.T.04633 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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