Provider Demographics
NPI:1740247667
Name:LAUGHBAUM, SUSAN (ATC, LAT, CSCS)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:LAUGHBAUM
Suffix:
Gender:F
Credentials:ATC, LAT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10800 WINERY RD
Mailing Address - Street 2:
Mailing Address - City:WADESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47638-9540
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10800 WINERY RD
Practice Address - Street 2:
Practice Address - City:WADESVILLE
Practice Address - State:IN
Practice Address - Zip Code:47638-9540
Practice Address - Country:US
Practice Address - Phone:812-963-0948
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN360001902255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer