Provider Demographics
NPI:1770838575
Name:LAUDNER, DIMPLE (PTA)
Entity Type:Individual
Prefix:
First Name:DIMPLE
Middle Name:
Last Name:LAUDNER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 ONTELL CT
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22554-1566
Mailing Address - Country:US
Mailing Address - Phone:540-272-0898
Mailing Address - Fax:
Practice Address - Street 1:2777 JEFFERSON DAVIS HWY
Practice Address - Street 2:SUITE 109
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22554-8323
Practice Address - Country:US
Practice Address - Phone:540-318-8615
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-17
Last Update Date:2012-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2306602094225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant