MEDICARE: EMILEE LANDIS DPT

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

General Provider Information

NPI Number	:	1134909484
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILEE LANDIS DPT

Provider Business Mailing Address
First Line	:	2668 E CITIZENS DR STE 5
Second Line	:
City	:	FAYETTEVILLE
State	:	AR
Zip	:	72703-4796
Country	:	US
Telephone Number	:	479-442-7473
Fax Number	:

Provider Business Practice Location Address
First Line	:	1188 N SALEM RD STE 1
Second Line	:
City	:	FAYETTEVILLE
State	:	AR
Zip	:	72704-8807
Country	:	US
Telephone Number	:	479-442-7473
Fax Number	:	479-239-5444

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

Provider Enumeration Date	:	10/04/2023
Last Update Date	:	07/07/2025

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Directions to “ EMILEE LANDIS DPT” Practice Location

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