Provider Demographics
NPI:1053890459
Name:LAUDEL, MATTHEW RICHMOND (PT, DPT)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:RICHMOND
Last Name:LAUDEL
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1750 FOUNDERS PKWY STE 126
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30009-7600
Mailing Address - Country:US
Mailing Address - Phone:770-442-0727
Mailing Address - Fax:770-343-9607
Practice Address - Street 1:1750 FOUNDERS PKWY STE 126
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30009-7600
Practice Address - Country:US
Practice Address - Phone:770-442-0727
Practice Address - Fax:770-343-9607
Is Sole Proprietor?:No
Enumeration Date:2018-08-07
Last Update Date:2022-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT135132081S0010X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine