MEDICARE: MICHAEL J LANDOCH 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	PT12441	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	OPT124410	OTHER	CA	BLUE SHIELD

General Provider Information

NPI Number	:	1578643573
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL J LANDOCH PT

Provider Business Mailing Address
First Line	:	6214 W MANCHESTER AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90045-3801
Country	:	US
Telephone Number	:	310-348-8464
Fax Number	:	310-348-8470

Provider Business Practice Location Address
First Line	:	6214 W MANCHESTER AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90045-3801
Country	:	US
Telephone Number	:	310-348-8464
Fax Number	:	310-348-8470

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

Provider Enumeration Date	:	10/16/2006
Last Update Date	:	07/08/2007

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Directions to “ MICHAEL J LANDOCH PT” Practice Location

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