Healthcare Provider Details

I. General information

NPI: 1457547291
Provider Name (Legal Business Name): ERIC J. LAUDENSLAGER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2007
Last Update Date: 08/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1630 W REDLANDS BLVD L
REDLANDS CA
92373-8032
US

IV. Provider business mailing address

33492 OAK GLEN RD H
YUCAIPA CA
92399-2096
US

V. Phone/Fax

Practice location:
  • Phone: 909-797-5155
  • Fax: 909-797-2768
Mailing address:
  • Phone: 909-797-5155
  • Fax: 909-797-2768

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberPT8450
License Number StateCA

VIII. Authorized Official

Name: ERIC LAUDENSLAGER
Title or Position: PT/OWNER
Credential: M.P.T.
Phone: 909-797-5155