Provider Demographics
NPI:1912676610
Name:LAUDERMILCH, SARA MARIE
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:MARIE
Last Name:LAUDERMILCH
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 1:269 WATCH HILL RD
Mailing Address - Street 2:
Mailing Address - City:EXTON
Mailing Address - State:PA
Mailing Address - Zip Code:19341-2190
Mailing Address - Country:US
Mailing Address - Phone:484-947-3851
Mailing Address - Fax:
Practice Address - Street 1:110 PIPEMAKERS CIR STE 115
Practice Address - Street 2:
Practice Address - City:POOLER
Practice Address - State:GA
Practice Address - Zip Code:31322-4168
Practice Address - Country:US
Practice Address - Phone:912-988-1526
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-07
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD286572251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics