Provider Demographics
NPI:1144214321
Name:LANDRY, RICKY JAMES (ATC, PTA)
Entity type:Individual
Prefix:MR
First Name:RICKY
Middle Name:JAMES
Last Name:LANDRY
Suffix:
Gender:M
Credentials:ATC, PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3403 E SIMCOE ST
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70501-6540
Mailing Address - Country:US
Mailing Address - Phone:337-269-1936
Mailing Address - Fax:
Practice Address - Street 1:816 HARDING ST
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-2320
Practice Address - Country:US
Practice Address - Phone:337-232-3111
Practice Address - Fax:337-232-5400
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LALA001958G225200000X
LAATH.J001132255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Not Answered2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer