Healthcare Provider Details

I. General information

NPI: 1891623658
Provider Name (Legal Business Name): HOANG THAO LAVIGNE PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 W CHANDLER BLVD
CHANDLER AZ
85226-3601
US

IV. Provider business mailing address

21680 N DIETZ DR
MARICOPA AZ
85138-5544
US

V. Phone/Fax

Practice location:
  • Phone: 480-554-2323
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA-008908
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: