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General NPI Number Information
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NPI Number | 1609698000
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Entity Type | Individual
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Provider Name | TREVER D LANDRY LMT, CPT
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Gender | Male
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Dates
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Enumeration Date | 10/28/2024
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Last Update Date | 12/11/2025
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Provider Practice Location Address
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Address Line | 201 E MAIN ST
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City | DELCAMBRE
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State | LA
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Zip | 70528-3011
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Country | US
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Telephone | 337-335-8664
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Fax |
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Provider Business Mailing Address
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Address Line | 2413 E SAINT VRAIN ST APT 101
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City | COLORADO SPRINGS
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State | CO
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Zip | 80909-4851
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Country | US
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Telephone | 337-335-8664
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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 | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MT.0025836
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License Number State | CO
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