Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2251S0007X | Physical Therapist - Sports | PT5921 | NM |
Y | 2251X0800X | Physical Therapist - Orthopedic | PT5921 |
NPI | 1558036210 |
---|---|
Provider Name | Kory James Landers |
First Address | Albuquerque, NM 87110-2248 |
Second Address | Albuquerque, NM 87113-2121 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/08/2021 |
Last Update Date | 13/08/2021 |