MEDICARE: MR. TIMOTHY D LANDON PT

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	PT1054	AK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1275563371
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. TIMOTHY D LANDON PT

Provider Business Mailing Address
First Line	:	22621 NORTHWOODS DR
Second Line	:
City	:	CHUGIAK
State	:	AK
Zip	:	99567-5459
Country	:	US
Telephone Number	:	907-746-7300
Fax Number	:	907-746-7302

Provider Business Practice Location Address
First Line	:	7335 E PALMER-WASILLA HIGHWAY
Second Line	:	SUITE C
City	:	PALMER
State	:	AK
Zip	:	99645
Country	:	US
Telephone Number	:	907-746-7300
Fax Number	:	907-746-7302

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

Provider Enumeration Date	:	07/04/2006
Last Update Date	:	07/08/2007

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