Provider Demographics
NPI:1114645447
Name:ALANIS LAFARGA, ANDY MARTIN (PT, DPT)
Entity Type:Individual
Prefix:MR
First Name:ANDY
Middle Name:MARTIN
Last Name:ALANIS LAFARGA
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 1:2912 W MONTECITO AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85017-4125
Mailing Address - Country:US
Mailing Address - Phone:602-471-1321
Mailing Address - Fax:
Practice Address - Street 1:10750 W MCDOWELL RD STE B210
Practice Address - Street 2:
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85392-5973
Practice Address - Country:US
Practice Address - Phone:623-907-0746
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-22
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
AZLPT-32515225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist