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General NPI Number Information
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NPI Number | 1922290691
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Entity Type | Individual
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Provider Name | CECILIA K LAND P.T
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Gender | Female
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Dates
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Enumeration Date | 08/15/2007
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Last Update Date | 08/15/2007
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Provider Practice Location Address
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Address Line | 1108 ROSS CLARK CIR
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City | DOTHAN
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State | AL
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Zip | 36301-3022
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Country | US
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Telephone | 334-793-8719
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Fax | 334-712-3553
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Provider Business Mailing Address
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Address Line | 212 WAYNESBORO WAY
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City | DOTHAN
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State | AL
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Zip | 36305-6344
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Country | US
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Telephone | 334-702-1468
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Fax | 334-712-3553
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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 | PTH1614
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License Number State | AL
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