Provider Demographics
NPI:1063561504
Name:LAUDENSLAGER, ERIC JOHN (MPT)
Entity type:Individual
Prefix:MR
First Name:ERIC
Middle Name:JOHN
Last Name:LAUDENSLAGER
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:33492 OAK GLEN RD
Mailing Address - Street 2:SUITE H
Mailing Address - City:YUCAIPA
Mailing Address - State:CA
Mailing Address - Zip Code:92399-2096
Mailing Address - Country:US
Mailing Address - Phone:909-797-5155
Mailing Address - Fax:909-797-2768
Practice Address - Street 1:33492 OAK GLEN RD
Practice Address - Street 2:SUITE H
Practice Address - City:YUCAIPA
Practice Address - State:CA
Practice Address - Zip Code:92399-2096
Practice Address - Country:US
Practice Address - Phone:909-797-5155
Practice Address - Fax:909-797-2768
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPT8450225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00PT84502OtherMEDICARE