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General NPI Number Information
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NPI Number | 1427542612
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Entity Type | Individual
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Provider Name | VINCENT D LAUDERDALE PT,DPT
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Gender | Male
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Dates
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Enumeration Date | 06/20/2018
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Last Update Date | 06/20/2018
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Provider Practice Location Address
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Address Line | 401 S 3RD ST
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City | ENID
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State | OK
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Zip | 73701-5737
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Country | US
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Telephone | 580-548-1164
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Fax |
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Provider Business Mailing Address
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Address Line | 401 S 3RD ST
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City | ENID
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State | OK
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Zip | 73701-5737
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Country | US
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Telephone | 580-548-1164
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 4935
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License Number State | OK
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