Provider Demographics
NPI:1679818926
Name:LACRUE, ELIZABETH K (DPT)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:K
Last Name:LACRUE
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 1:221 W FIR AVE
Mailing Address - Street 2:STE 105
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93611-0221
Mailing Address - Country:US
Mailing Address - Phone:559-325-3444
Mailing Address - Fax:559-325-7444
Practice Address - Street 1:221 W FIR AVE
Practice Address - Street 2:STE 105
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93611-0221
Practice Address - Country:US
Practice Address - Phone:559-325-3444
Practice Address - Fax:559-325-7444
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-27
Last Update Date:2012-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36907225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist