MEDICARE: MR. ALBERT LANDA 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	001885	NY

General Provider Information

NPI Number	:	1528066891
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ALBERT LANDA PT

Provider Business Mailing Address
First Line	:	55 EIGHTH AVE
Second Line	:	ALBERT LANDA PT PC
City	:	BROOKLYN
State	:	NY
Zip	:	11217
Country	:	US
Telephone Number	:	718-789-7878
Fax Number	:	718-789-3749

Provider Business Practice Location Address
First Line	:	55 EIGHTH AVE
Second Line	:	ALBERT LANDA PT PC
City	:	BROOKLYN
State	:	NY
Zip	:	11217
Country	:	US
Telephone Number	:	718-789-7878
Fax Number	:	718-789-3749

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

Provider Enumeration Date	:	07/12/2005
Last Update Date	:	10/18/2007

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