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General NPI Number Information
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NPI Number | 1457470023
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Entity Type | Individual
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Provider Name | LORI ANNE LANDRUM PT, DPT
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Gender | Female
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Dates
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Enumeration Date | 03/28/2007
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Last Update Date | 04/24/2017
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Provider Practice Location Address
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Address Line | 204 N 15TH AVE
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City | LAUREL
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State | MS
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Zip | 39440-4122
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Country | US
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Telephone | 601-342-2344
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Fax | 601-342-2344
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Provider Business Mailing Address
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Address Line | 43 LANDRUM RD
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City | OVETT
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State | MS
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Zip | 39464-3735
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Country | US
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Telephone | 601-319-5304
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT1798
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License Number State | MS
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