Healthcare Provider Details

I. General information

NPI: 1730066390
Provider Name (Legal Business Name): LANDON DAVID THOMAS DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2025
Last Update Date: 08/18/2025
Certification Date: 08/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4138 19TH ST
LUBBOCK TX
79407-2403
US

IV. Provider business mailing address

PO BOX 932184 PO BOX 932184
ATLANTA GA
31193-0001
US

V. Phone/Fax

Practice location:
  • Phone: 806-780-2329
  • Fax:
Mailing address:
  • Phone: 856-678-3484
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1407071
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: