MEDICARE: MICHAEL LANDIN PT, 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	1248891	TX

General Provider Information

NPI Number	:	1780085910
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL LANDIN PT, DPT

Provider Business Mailing Address
First Line	:	2210 NW MILITARY HWY STE 101
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78213-1815
Country	:	US
Telephone Number	:	210-308-5558
Fax Number	:	210-308-5557

Provider Business Practice Location Address
First Line	:	2210 NW MILITARY HWY STE 101
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78213-1815
Country	:	US
Telephone Number	:	210-308-5558
Fax Number	:	210-308-5557

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

Provider Enumeration Date	:	09/08/2014
Last Update Date	:	09/08/2014

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