Healthcare Provider Details

I. General information

NPI: 1669524195
Provider Name (Legal Business Name): LANDERS PHYSICAL THERAPY SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 10/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 S POLK ST SUITE 2
COVINGTON LA
70433-2474
US

IV. Provider business mailing address

1010 S POLK ST SUITE 2
COVINGTON LA
70433-2474
US

V. Phone/Fax

Practice location:
  • Phone: 985-809-9088
  • Fax: 985-809-9270
Mailing address:
  • Phone: 985-809-9088
  • Fax: 985-809-9270

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT04633
License Number StateLA

VIII. Authorized Official

Name: DR. P.J. LANDERS
Title or Position: DOCTOR OF PHYSICAL THERAPY
Credential: DPT, MTC, OCS
Phone: 985-809-9088