Provider Demographics
NPI:1154412286
Name:LANDRY, THOMAS J (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:J
Last Name:LANDRY
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 JEFFERSON TER
Mailing Address - Street 2:SUITE B
Mailing Address - City:NEW IBERIA
Mailing Address - State:LA
Mailing Address - Zip Code:70560-4981
Mailing Address - Country:US
Mailing Address - Phone:337-560-9675
Mailing Address - Fax:337-560-9678
Practice Address - Street 1:510 JEFFERSON TER
Practice Address - Street 2:STE. B
Practice Address - City:NEW IBERIA
Practice Address - State:LA
Practice Address - Zip Code:70560-4981
Practice Address - Country:US
Practice Address - Phone:337-560-9675
Practice Address - Fax:337-560-9675
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2012-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPT00304225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA56351Medicare ID - Type Unspecified