MEDICARE: MRS. CHARESE RENE LANDE PHYSICAL THERAPIST

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	1037026	TX
2	225700000X	Massage Therapist	MT025709	TX

General Provider Information

NPI Number	:	1063676922
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CHARESE RENE LANDE PHYSICAL THERAPIST

Provider Business Mailing Address
First Line	:	7905 MESA TRAILS CIRCLE
Second Line	:	HEALTHCARE
City	:	AUSTIN
State	:	TX
Zip	:	78731-1730
Country	:	US
Telephone Number	:	512-769-8464
Fax Number	:

Provider Business Practice Location Address
First Line	:	7905 MESA TRAILS CIR
Second Line	:	HEALTHCARE
City	:	AUSTIN
State	:	TX
Zip	:	78731-1446
Country	:	US
Telephone Number	:	512-769-8464
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/10/2008
Last Update Date	:	11/22/2016

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