Provider Demographics
NPI:1841012598
Name:WESTDORP, LARA LYNN ROHOLT
Entity type:Individual
Prefix:
First Name:LARA
Middle Name:LYNN ROHOLT
Last Name:WESTDORP
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 1:6640 JEFFERSON BLVD
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21703-5816
Mailing Address - Country:US
Mailing Address - Phone:301-371-8556
Mailing Address - Fax:
Practice Address - Street 1:129 W PATRICK ST STE 13C
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-5551
Practice Address - Country:US
Practice Address - Phone:301-371-8556
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-24
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173C00000XOther Service ProvidersReflexologist