MEDICARE: JULIE K LANDECKER 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	41483	CA

General Provider Information

NPI Number	:	1780647693
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIE K LANDECKER DPT

Provider Business Mailing Address
First Line	:	220 CONCOURSE BLVD
Second Line	:
City	:	SANTA ROSA
State	:	CA
Zip	:	95403-8210
Country	:	US
Telephone Number	:	844-527-7369
Fax Number	:	844-847-4943

Provider Business Practice Location Address
First Line	:	220 CONCOURSE BLVD
Second Line	:
City	:	SANTA ROSA
State	:	CA
Zip	:	95403-8210
Country	:	US
Telephone Number	:	844-527-7369
Fax Number	:	844-847-4943

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

Provider Enumeration Date	:	04/11/2006
Last Update Date	:	03/09/2026

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