Provider Demographics
NPI:1003354192
Name:LAUDER, WILLIAM (DPT)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:LAUDER
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:WILL
Other - Middle Name:
Other - Last Name:LAUDER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPT
Mailing Address - Street 1:2251 COUNTRY CLUB LN
Mailing Address - Street 2:
Mailing Address - City:SELMA
Mailing Address - State:CA
Mailing Address - Zip Code:93662-3859
Mailing Address - Country:US
Mailing Address - Phone:559-896-6565
Mailing Address - Fax:
Practice Address - Street 1:2251 COUNTRY CLUB LN
Practice Address - Street 2:
Practice Address - City:SELMA
Practice Address - State:CA
Practice Address - Zip Code:93662-3859
Practice Address - Country:US
Practice Address - Phone:559-896-6565
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-08
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA292764225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist