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NPI Code Detail

MEDICARE: MR. KEVIN E. LANDA PT, MTC

MEDICARE: MR. KEVIN E. LANDA PT, MTC
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
12251X0800XOrthopedic Physical TherapistPT000908EPA

General Provider Information

NPI Number : 1740281351
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. KEVIN E. LANDA PT, MTC
Provider Business Mailing Address
First Line : 656 PHILADELPHIA AVE
Second Line :
City : SHILLINGTON
State : PA
Zip : 19607-2769
Country : US
Telephone Number : 610-775-9077
Fax Number : 610-775-9149
Provider Business Practice Location Address
First Line : 656 PHILADELPHIA AVE
Second Line :
City : SHILLINGTON
State : PA
Zip : 19607-2769
Country : US
Telephone Number : 610-775-9077
Fax Number : 610-775-9149
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/04/2005
Last Update Date : 07/08/2007

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