Provider Demographics
NPI:1346627429
Name:LANDAETA, VALERIE (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:VALERIE
Middle Name:
Last Name:LANDAETA
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:DR
Other - First Name:VALERIE
Other - Middle Name:
Other - Last Name:LOUCKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:5241 CURRY RD
Mailing Address - Street 2:
Mailing Address - City:TRUMANSBURG
Mailing Address - State:NY
Mailing Address - Zip Code:14886-9552
Mailing Address - Country:US
Mailing Address - Phone:585-409-8683
Mailing Address - Fax:
Practice Address - Street 1:101 DATES DR
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-1383
Practice Address - Country:US
Practice Address - Phone:607-274-4011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-28
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY038593225100000X
PAPT024136225100000X
VA2305209095225100000X
TX1249907225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist