Provider Demographics
NPI:1174753016
Name:LANDRUM, TERRY LEE (PT)
Entity type:Individual
Prefix:MR
First Name:TERRY
Middle Name:LEE
Last Name:LANDRUM
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1040 1ST AVE
Mailing Address - Street 2:#333
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-2991
Mailing Address - Country:US
Mailing Address - Phone:646-226-1447
Mailing Address - Fax:
Practice Address - Street 1:428 E 58TH ST
Practice Address - Street 2:SUITE 1
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-2329
Practice Address - Country:US
Practice Address - Phone:646-226-1447
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-24
Last Update Date:2009-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0224952251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic