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General NPI Number Information
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NPI Number | 1982840187
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Entity Type | Organization
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Legal Business Name | LANDRY PHYSICAL THERAPY & WELLNESS SERVICES, LLC
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Dates
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Enumeration Date | 12/18/2008
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Last Update Date | 05/05/2009
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Provider Practice Location Address
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Address Line | 111 CHURCH RD
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City | MARLTON
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State | NJ
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Zip | 08053-9410
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Country | US
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Telephone | 856-334-8549
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Fax | 866-812-0413
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Provider Business Mailing Address
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Address Line | PO BOX 253
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City | HADDONFIELD
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State | NJ
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Zip | 08033-0173
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Country | US
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Telephone | 856-334-8549
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Fax | 866-812-0413
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Authorized Official
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Title or Position | CEO
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Name | DR. CHERYL LANDRY
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Credential | P.T.
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Telephone | 856-334-8549
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 40QA00871000
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License Number State | NJ
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