Individual
MR. EDWIN DALE LANDON JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
428 BRIDGE ST NW, GRAND RAPIDS, MI 49504-5322
(616) 451-4284
(616) 451-4811
Mailing address
428 BRIDGE ST NW, GRAND RAPIDS, MI 49504-5322
(616) 451-4284
(616) 451-4811
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
55020002800
MI
Other
Enumeration date
08/16/2012
Last updated
08/16/2012
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