Provider Demographics
NPI:1285014381
Name:LACROIX, ANGELA
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:LACROIX
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1805 N SCOTTSDALE RD
Mailing Address - Street 2:2
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85281-1556
Mailing Address - Country:US
Mailing Address - Phone:480-941-4169
Mailing Address - Fax:480-941-4972
Practice Address - Street 1:1805 N SCOTTSDALE RD
Practice Address - Street 2:2
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85281-1556
Practice Address - Country:US
Practice Address - Phone:480-941-4169
Practice Address - Fax:480-941-4972
Is Sole Proprietor?:No
Enumeration Date:2015-06-03
Last Update Date:2015-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ11571225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist