Provider Demographics
NPI:1427771476
Name:LANDFATHER, JEREMY (LMT)
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:
Last Name:LANDFATHER
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1548 S US HIGHWAY 231 STE E1
Mailing Address - Street 2:
Mailing Address - City:OZARK
Mailing Address - State:AL
Mailing Address - Zip Code:36360-4516
Mailing Address - Country:US
Mailing Address - Phone:334-443-0460
Mailing Address - Fax:
Practice Address - Street 1:1548 S US HIGHWAY 231 STE E1
Practice Address - Street 2:
Practice Address - City:OZARK
Practice Address - State:AL
Practice Address - Zip Code:36360-4516
Practice Address - Country:US
Practice Address - Phone:334-443-0460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-23
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4842225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist