MEDICARE: MS. ELLEN A LANDOWSKI 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	011719	NY

General Provider Information

NPI Number	:	1669467734
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ELLEN A LANDOWSKI PT

Provider Business Mailing Address
First Line	:	4567 CROSSROADS PARK DR
Second Line	:	2ND FLOOR
City	:	LIVERPOOL
State	:	NY
Zip	:	13088-3589
Country	:	US
Telephone Number	:	315-295-2100
Fax Number	:	315-295-2126

Provider Business Practice Location Address
First Line	:	4700 ONONDAGA BLVD
Second Line	:
City	:	SYRACUSE
State	:	NY
Zip	:	13219-3316
Country	:	US
Telephone Number	:	315-475-7121
Fax Number	:	315-475-7144

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

Provider Enumeration Date	:	09/15/2005
Last Update Date	:	07/08/2007

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