Healthcare Provider Details

I. General information

NPI: 1730206426
Provider Name (Legal Business Name): DR. TODD LANDSBERG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: TODD LANDSBERG AUD CCC-A

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 05/06/2025
Certification Date: 05/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MEDICAL PKWY STE 120
LAKEWAY TX
78738-1792
US

IV. Provider business mailing address

PO BOX 844658
DALLAS TX
75284-4658
US

V. Phone/Fax

Practice location:
  • Phone: 512-654-1234
  • Fax: 855-563-2794
Mailing address:
  • Phone: 254-724-2111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number7340
License Number StateND
# 2
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number81495
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: