Provider Demographics
NPI:1922165794
Name:LAIDLER, GRAHAM ALEXANDER (PT)
Entity Type:Individual
Prefix:
First Name:GRAHAM
Middle Name:ALEXANDER
Last Name:LAIDLER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:423-238-7217
Mailing Address - Fax:423-362-8684
Practice Address - Street 1:1106 FOUNTAIN PARK CIR
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31520-4806
Practice Address - Country:US
Practice Address - Phone:912-262-2151
Practice Address - Fax:912-262-2754
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
GAPT008385225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA375060893BMedicaid
12117846OtherCAQH
GA375060893EMedicaid
GA375060893DMedicaid
GA375060893FMedicaid