Individual provider Active NPI

Landon Prather, PT, DPT

  • Physical Therapist
  • Shawnee, OK
National Provider Identifier
1508434762
Registry record updated Jun 15, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
6013 Issued in OK
Practice address
781 Grand Casino Blvd
Shawnee, OK 74804-1005
Phone
(405) 615-6004
NPI assigned
Jun 15, 2021
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 15, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 6013 OK Primary

Addresses

Primary practice location

781 Grand Casino Blvd
Shawnee, OK 74804-1005

Mailing address

781 Grand Casino Blvd
Shawnee, OK 74804-1005

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AK

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250917001132 AK Practitioner - Physical Therapist in Private Practice 8921502683 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Progressive Physical TherapyGroup PAC ID 2668861931, 21 clinicians

Practice addresses (Care Compare)

2221 E Northern Lights Blvd
Suite 108
Anchorage, AK 99508-4140
Phone (907) 748-0022

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
6013OKMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Progressive Physical Therapy Physical Therapist CurrentSince Aug 4, 2025 Accepting new patients

Locations

2221 E Northern Lights Blvd
Ste 106
Anchorage, AK 99508
Phone (907) 677-5605

718 K St
Ste D
Anchorage, AK 99501
Phone (907) 748-0022

2221 E Northern Lights Blvd
Ste 108
Anchorage, AK 99508
Phone (907) 277-5337

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1623715200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1623715200000",
    "number": "1508434762",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "781 GRAND CASINO BLVD",
            "city": "SHAWNEE",
            "state": "OK",
            "postal_code": "748041005"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "781 GRAND CASINO BLVD",
            "city": "SHAWNEE",
            "state": "OK",
            "postal_code": "748041005",
            "telephone_number": "405-615-6004"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PRATHER",
        "first_name": "LANDON",
        "credential": "PT, DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-06-15",
        "last_updated": "2021-06-15",
        "certification_date": "2021-06-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "OK",
            "license": "6013",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Shawnee, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.