Healthcare Provider Details

I. General information

NPI: 1609203371
Provider Name (Legal Business Name): ERICA JADE LANDERS DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2013
Last Update Date: 12/16/2019
Certification Date: 12/16/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2211 W MAGNOLIA BLVD STE 160
BURBANK CA
91506-1757
US

IV. Provider business mailing address

5767 W CENTURY BLVD STE 400
LOS ANGELES CA
90045-5631
US

V. Phone/Fax

Practice location:
  • Phone: 818-876-4195
  • Fax: 818-729-0410
Mailing address:
  • Phone:
  • Fax: 310-496-0868

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number36901
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number36901
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: