Provider Demographics
NPI:1063050029
Name:SEGER, LANDIS EILEEN (PT)
Entity type:Individual
Prefix:
First Name:LANDIS
Middle Name:EILEEN
Last Name:SEGER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:LANDIS
Other - Middle Name:EILEEN
Other - Last Name:PTENTICE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10 S 9TH ST
Mailing Address - Street 2:STE 4
Mailing Address - City:NOBLESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46060-2631
Mailing Address - Country:US
Mailing Address - Phone:937-294-2468
Mailing Address - Fax:937-294-2394
Practice Address - Street 1:6500 INTERCHANGE RD S STE A
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47715-8210
Practice Address - Country:US
Practice Address - Phone:812-477-5000
Practice Address - Fax:812-477-5002
Is Sole Proprietor?:No
Enumeration Date:2019-12-20
Last Update Date:2020-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05004664A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist