Provider Demographics
NPI:1639437619
Name:LAUDNER, JAYECE R (PT)
Entity Type:Individual
Prefix:MS
First Name:JAYECE
Middle Name:R
Last Name:LAUDNER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:JAYECE
Other - Middle Name:R
Other - Last Name:OLSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:1485 N. TURQUOISE DR.
Mailing Address - Street 2:SUITE 220
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001
Mailing Address - Country:US
Mailing Address - Phone:928-774-6626
Mailing Address - Fax:928-214-3277
Practice Address - Street 1:1485 N. TURQUOISE DR.
Practice Address - Street 2:SUITE 220
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001
Practice Address - Country:US
Practice Address - Phone:928-774-6626
Practice Address - Fax:928-214-3277
Is Sole Proprietor?:No
Enumeration Date:2012-04-27
Last Update Date:2013-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ9001174400000X
AZ767225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ698464Medicaid