Provider Demographics
NPI:1770685042
Name:CROXFORD, ANGELA MARIE (MPT)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:MARIE
Last Name:CROXFORD
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:MISS
Other - First Name:ANGELA
Other - Middle Name:MARIE
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:10562 SENNIT AVE
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92843-5334
Mailing Address - Country:US
Mailing Address - Phone:949-307-7622
Mailing Address - Fax:562-596-7214
Practice Address - Street 1:6695 E PACIFIC COAST HWY
Practice Address - Street 2:SUITE 100
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90803-4235
Practice Address - Country:US
Practice Address - Phone:562-596-7074
Practice Address - Fax:562-596-7214
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2012-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT32539225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist