Provider Demographics
NPI:1629102561
Name:LAUDER, JAMES A (PT)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:A
Last Name:LAUDER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 VICTORIA LN
Mailing Address - Street 2:
Mailing Address - City:FROSTBURG
Mailing Address - State:MD
Mailing Address - Zip Code:21532-1445
Mailing Address - Country:US
Mailing Address - Phone:301-268-9995
Mailing Address - Fax:
Practice Address - Street 1:21907 WESTERNPORT RD SW
Practice Address - Street 2:
Practice Address - City:WESTERNPORT
Practice Address - State:MD
Practice Address - Zip Code:21562-2235
Practice Address - Country:US
Practice Address - Phone:301-786-4171
Practice Address - Fax:301-786-4203
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD19198225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist