Healthcare Provider Details

I. General information

NPI: 1003145715
Provider Name (Legal Business Name): JOSHUA N LACANLALE P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2009
Last Update Date: 01/03/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3035 S ELLSWORTH RD BLDG 4, #128
MESA AZ
85212-2160
US

IV. Provider business mailing address

PO BOX 32490
PHOENIX AZ
85064-2490
US

V. Phone/Fax

Practice location:
  • Phone: 480-357-6500
  • Fax: 480-357-6515
Mailing address:
  • Phone: 602-230-4478
  • Fax: 602-230-9962

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number8754
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: