Healthcare Provider Details

I. General information

NPI: 1821247917
Provider Name (Legal Business Name): LORI ANN LANDER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2008
Last Update Date: 06/19/2023
Certification Date: 06/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 EUCLID AVE # A40
CLEVELAND OH
44195-1960
US

IV. Provider business mailing address

3880 NORTHWOODS CT NE APT. 4
WARREN OH
44483-4593
US

V. Phone/Fax

Practice location:
  • Phone: 216-444-2200
  • Fax:
Mailing address:
  • Phone: 330-565-8386
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA055871
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.004189
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT-6928
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: