Provider Demographics
NPI:1558831966
Name:LASPADA, RAYMOND PHILLIP (MPT)
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:PHILLIP
Last Name:LASPADA
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2922 HOWARD AVE UNIT D
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29577-1901
Mailing Address - Country:US
Mailing Address - Phone:609-458-1744
Mailing Address - Fax:843-712-1580
Practice Address - Street 1:2922 HOWARD AVE UNIT D
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29577-1901
Practice Address - Country:US
Practice Address - Phone:609-458-1744
Practice Address - Fax:843-712-1580
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-28
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC9238225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist