Provider Demographics
NPI:1588072896
Name:ROCKEFELLER, LAURINDA (PTA)
Entity type:Individual
Prefix:MRS
First Name:LAURINDA
Middle Name:
Last Name:ROCKEFELLER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4301 JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:SYKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21784-9721
Mailing Address - Country:US
Mailing Address - Phone:443-277-4368
Mailing Address - Fax:
Practice Address - Street 1:4301 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:SYKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21784-9721
Practice Address - Country:US
Practice Address - Phone:443-277-4368
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-30
Last Update Date:2014-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA3395225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant