Individual
GRAHAM ALEXANDER LAIDLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
1106 FOUNTAIN PARK CIR, BRUNSWICK, GA 31520-4806
(912) 262-2151
(912) 262-2754
Mailing address
790 REMINGTON BLVD, BOLINGBROOK, IL 60440-4909
(423) 238-7217
(423) 362-8684
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT008385
GA
225100000X
Physical Therapist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12117846
CAQH
—
05
—
375060893B
—
GA
05
—
375060893D
—
GA
05
—
375060893E
—
GA
05
—
375060893F
—
GA
Enumeration date
01/02/2007
Last updated
10/27/2023
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