Provider Demographics
NPI:1841470044
Name:TEPER-LACROSSE, KRISTEN MARIE (PT)
Entity type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:MARIE
Last Name:TEPER-LACROSSE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35840 CHESTER RD STE F
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:OH
Mailing Address - Zip Code:44011-1240
Mailing Address - Country:US
Mailing Address - Phone:440-937-5210
Mailing Address - Fax:440-937-5212
Practice Address - Street 1:35840 CHESTER RD
Practice Address - Street 2:SUITE F
Practice Address - City:AVON
Practice Address - State:OH
Practice Address - Zip Code:44011-1240
Practice Address - Country:US
Practice Address - Phone:440-937-5210
Practice Address - Fax:440-937-5212
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-06
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH06698225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist