Provider Demographics
NPI:1356017610
Name:LEQUANG, ANGELIE VO (DPT)
Entity Type:Individual
Prefix:DR
First Name:ANGELIE
Middle Name:VO
Last Name:LEQUANG
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 N ESTRELLA PKWY STE 50
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85338-9279
Mailing Address - Country:US
Mailing Address - Phone:623-882-2992
Mailing Address - Fax:
Practice Address - Street 1:750 N ESTRELLA PKWY STE 50
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85338-9279
Practice Address - Country:US
Practice Address - Phone:623-882-2992
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-18
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPT-31928225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist