Individual
LANDON TATE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
902 S MCLEANSBORO ST, BENTON, IL 62812-3413
(618) 439-4501
Mailing address
2907 WILLIAMSON COUNTY PKWY, MARION, IL 62959-5256
(618) 998-9894
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
160.006481
IL
Other
Enumeration date
06/04/2014
Last updated
06/04/2014
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