Provider Demographics
NPI:1124521463
Name:LAUDENSLAGER, PATRICIA JEAN
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:JEAN
Last Name:LAUDENSLAGER
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 1:3665 BELLOWS DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-5619
Mailing Address - Country:US
Mailing Address - Phone:248-909-4768
Mailing Address - Fax:
Practice Address - Street 1:2160 COOLIDGE HWY
Practice Address - Street 2:
Practice Address - City:BERKLEY
Practice Address - State:MI
Practice Address - Zip Code:48072-1547
Practice Address - Country:US
Practice Address - Phone:248-691-4700
Practice Address - Fax:248-691-4710
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-13
Last Update Date:2018-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI55010041362251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic