Individual
TRACI LAUDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
6040 LUTE RD, PORTAGE, IN 46368-5008
(219) 763-6858
Mailing address
539 S 300 E, KOUTS, IN 46347
(219) 462-8149
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
06002130A
IN
Other
Enumeration date
07/11/2007
Last updated
07/11/2007
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