Provider Demographics
NPI:1699222158
Name:LAUDICINA, SHAYNE G (DPT)
Entity Type:Individual
Prefix:DR
First Name:SHAYNE
Middle Name:G
Last Name:LAUDICINA
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 MITCHELL ST.
Mailing Address - Street 2:
Mailing Address - City:HEADLAND
Mailing Address - State:AL
Mailing Address - Zip Code:36345
Mailing Address - Country:US
Mailing Address - Phone:334-482-1984
Mailing Address - Fax:
Practice Address - Street 1:201 MITCHELL ST
Practice Address - Street 2:
Practice Address - City:HEADLAND
Practice Address - State:AL
Practice Address - Zip Code:36345-2137
Practice Address - Country:US
Practice Address - Phone:334-482-1984
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL30476225100000X
ALPTH6473225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist