Provider Demographics
NPI:1053761429
Name:BOOKER, LANDON G (DPT, PT)
Entity type:Individual
Prefix:
First Name:LANDON
Middle Name:G
Last Name:BOOKER
Suffix:
Gender:M
Credentials:DPT, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6307 CENTER STREET
Mailing Address - Street 2:SUITE 105
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68106
Mailing Address - Country:US
Mailing Address - Phone:402-884-7453
Mailing Address - Fax:402-884-6983
Practice Address - Street 1:6307 CENTER ST
Practice Address - Street 2:SUITE 105
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68106-3458
Practice Address - Country:US
Practice Address - Phone:402-884-7453
Practice Address - Fax:402-884-5983
Is Sole Proprietor?:No
Enumeration Date:2016-06-16
Last Update Date:2016-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE3570225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist