Provider Demographics
NPI:1033518204
Name:LACROSS, JENNIFER ANN (PT, DPT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ANN
Last Name:LACROSS
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:A
Other - Last Name:KURZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT ,DPT
Mailing Address - Street 1:3500 S BOULEVARD STE A1
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-5490
Mailing Address - Country:US
Mailing Address - Phone:405-513-8118
Mailing Address - Fax:
Practice Address - Street 1:3500 S BOULEVARD STE A1
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-5490
Practice Address - Country:US
Practice Address - Phone:405-513-8118
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-13
Last Update Date:2020-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT023835225100000X
OK5428225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist