MEDICARE: MR. RYAN LANDY P.T.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	004530	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184795254
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RYAN LANDY P.T.

Provider Business Mailing Address
First Line	:	700 PARK REGENCY PL NE
Second Line	:	1004
City	:	ATLANTA
State	:	GA
Zip	:	30326-1271
Country	:	US
Telephone Number	:	404-353-7759
Fax Number	:

Provider Business Practice Location Address
First Line	:	1508 ROCK QUARRY RD
Second Line	:
City	:	STOCKBRIDGE
State	:	GA
Zip	:	30281-5047
Country	:	US
Telephone Number	:	770-507-3233
Fax Number	:	770-507-4118

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/12/2006
Last Update Date	:	10/24/2011

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