Provider Demographics
NPI:1063489946
Name:LAPRADD, RICKY RANDALL JR (ATC)
Entity Type:Individual
Prefix:MR
First Name:RICKY
Middle Name:RANDALL
Last Name:LAPRADD
Suffix:JR
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5721 SIERRA DR
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24012-1111
Mailing Address - Country:US
Mailing Address - Phone:540-793-4739
Mailing Address - Fax:
Practice Address - Street 1:2102 GRANDIN RD SW
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24015-3528
Practice Address - Country:US
Practice Address - Phone:540-853-2158
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01260009662081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine