Basic Information
| Provider Information | |||||||||
| NPI: | 1194069351 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VANLANDINGHAM | ||||||||
| FirstName: | JUSTIN | ||||||||
| MiddleName: | ALLEN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1515 N CENTER ST | ||||||||
| Address2: | SUITE 5 | ||||||||
| City: | LONOKE | ||||||||
| State: | AR | ||||||||
| PostalCode: | 720862101 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5016765540 | ||||||||
| FaxNumber: | 5016766499 | ||||||||
| Practice Location | |||||||||
| Address1: | 1515 N CENTER ST | ||||||||
| Address2: | SUITE 5 | ||||||||
| City: | LONOKE | ||||||||
| State: | AR | ||||||||
| PostalCode: | 720862101 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5016765540 | ||||||||
| FaxNumber: | 5016766499 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/12/2012 | ||||||||
| LastUpdateDate: | 11/12/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT3552 | AR | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.