Individual
RICHARD CHARLES LANDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MSPT
Contact information
Practice address
1812 MARSH RD, STORE 505, WILMINGTON, DE 19810-4581
(302) 475-7500
(302) 475-5787
Mailing address
790 REMINGTON BLVD, BOLINGBROOK, IL 60440-4909
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
J1-0002838
DE
225100000X
Physical Therapist
PT015816
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LA1413014
BCBS
PA
01
—
P01089025
MEDICARE RAILROAD
PA
Enumeration date
09/20/2005
Last updated
11/21/2012
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