Provider Demographics
NPI:1891858817
Name:ROADCAP, LAURA
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:ROADCAP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1688 LAWRENCEVILLE HWY
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30044-4608
Mailing Address - Country:US
Mailing Address - Phone:770-995-2379
Mailing Address - Fax:770-995-2385
Practice Address - Street 1:1688 LAWRENCEVILLE HWY
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30044-4608
Practice Address - Country:US
Practice Address - Phone:770-995-2379
Practice Address - Fax:770-995-2385
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA000831174400000X
GAPT0008312251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered174400000XOther Service ProvidersSpecialist
Not Answered2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA10037760Medicaid
GA306070Medicaid