Provider Demographics
NPI:1639767379
Name:LODA, VADNEY ANN (PT)
Entity Type:Individual
Prefix:
First Name:VADNEY
Middle Name:ANN
Last Name:LODA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4237 E ORCHID LN
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296-9615
Mailing Address - Country:US
Mailing Address - Phone:602-684-0166
Mailing Address - Fax:
Practice Address - Street 1:4237 E ORCHID LN
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85296-9615
Practice Address - Country:US
Practice Address - Phone:520-876-0045
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-07
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ11578225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ11578OtherARIZONA STATE BOARD OF PHYSICAL THERAPY
CA294609OtherCALIFORNIA BOARD OF PHYSICAL THERAPY