Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | 8754 | AZ |
NPI | 1003145715 |
---|---|
Provider Name | Joshua N Lacanlale |
First Address | Phoenix, AZ 85064-2490 |
Second Address | Mesa, AZ 85212-2160 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/12/2009 |
Last Update Date | 03/01/2022 |