Provider Demographics
NPI:1679140909
Name:LANDRY, ERIN KATHLEEN
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:KATHLEEN
Last Name:LANDRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2145 COUNTRY CLUB RD STE 200
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-2404
Mailing Address - Country:US
Mailing Address - Phone:910-939-5937
Mailing Address - Fax:910-939-5292
Practice Address - Street 1:2145 COUNTRY CLUB RD STE 200
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-2404
Practice Address - Country:US
Practice Address - Phone:910-939-5937
Practice Address - Fax:910-939-5292
Is Sole Proprietor?:No
Enumeration Date:2021-06-07
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP20499225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist