MEDICARE: JAMIE LANDER

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	PTH4373	AL

General Provider Information

NPI Number	:	1528216983
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMIE LANDER

Provider Business Mailing Address
First Line	:	603 THEAKSTON ST
Second Line	:
City	:	FAIRHOPE
State	:	AL
Zip	:	36532-7661
Country	:	US
Telephone Number	:	251-422-9828
Fax Number	:

Provider Business Practice Location Address
First Line	:	21298 COTTON CREEK DR STE B
Second Line	:
City	:	GULF SHORES
State	:	AL
Zip	:	36542-9129
Country	:	US
Telephone Number	:	850-588-9641
Fax Number	:	850-391-4114

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

Provider Enumeration Date	:	08/28/2008
Last Update Date	:	07/06/2021

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Directions to “ JAMIE LANDER ” Practice Location

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