Provider Demographics
NPI:1972899003
Name:LANDRETH, DEBORAH JANE (DPT)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:JANE
Last Name:LANDRETH
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 BOULDIN AVE
Mailing Address - Street 2:UNIT A
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-3416
Mailing Address - Country:US
Mailing Address - Phone:214-437-8265
Mailing Address - Fax:
Practice Address - Street 1:1825 FORTVIEW RD STE 109
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-7655
Practice Address - Country:US
Practice Address - Phone:512-892-5250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-27
Last Update Date:2012-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1207646225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist