Active NPI
Gregory Landerman
- Physical Therapy Assistant
- San Augustine, TX
National Provider Identifier
1215417266
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 208166
- Practice address
- 451 S El Camino Xing
San Augustine, TX 75972-1666 - Phone
- (936) 275-2900
- NPI assigned
- Aug 20, 2018
- Last updated
- Aug 20, 2018
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | 208166 | UT | Primary |
Addresses
Primary practice location
451 S El Camino Xing
San Augustine, TX 75972-1666
Mailing address
3404 Rock Ridge St
Nacogdoches, TX 75965-3238
Phone (740) 586-5539
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 208166 | UT | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1534723200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1534723200000",
"number": "1215417266",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3404 ROCK RIDGE ST",
"city": "NACOGDOCHES",
"state": "TX",
"postal_code": "759653238",
"telephone_number": "740-586-5539"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "451 S EL CAMINO XING",
"city": "SAN AUGUSTINE",
"state": "TX",
"postal_code": "759721666",
"telephone_number": "936-275-2900"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LANDERMAN",
"first_name": "GREGORY",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-08-20",
"last_updated": "2018-08-20",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "UT",
"license": "208166",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Augustine, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.