MEDICARE: RAYMOND PHILLIP LASPADA MPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	9238	SC
2	2251P0200X	Pediatric Physical Therapist	9238	SC

General Provider Information

NPI Number	:	1558831966
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAYMOND PHILLIP LASPADA MPT

Provider Business Mailing Address
First Line	:	1581 CULBERTSON AVE
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29577-1885
Country	:	US
Telephone Number	:	609-458-1744
Fax Number	:	843-712-1580

Provider Business Practice Location Address
First Line	:	1581 CULBERTSON AVE
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29577-1885
Country	:	US
Telephone Number	:	609-458-1744
Fax Number	:	843-712-1580

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/28/2018
Last Update Date	:	06/27/2025

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