Healthcare Provider Details

I. General information

NPI: 1174460422
Provider Name (Legal Business Name): SAFIA LADNER PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 05/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

604 SOLAREX CT
FREDERICK MD
21703-7005
US

IV. Provider business mailing address

604 SOLAREX CT
FREDERICK MD
21703-7005
US

V. Phone/Fax

Practice location:
  • Phone: 240-215-9023
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA.P1.61375213
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: