Healthcare Provider Details

I. General information

NPI: 1336351881
Provider Name (Legal Business Name): PATRICIA L LANDGRAF MA, PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2653 S STRATFORD DR
BLOOMINGTON IN
47401-4147
US

IV. Provider business mailing address

2653 S STRATFORD DR
BLOOMINGTON IN
47401-4147
US

V. Phone/Fax

Practice location:
  • Phone: 812-272-1027
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number05005284A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: