Healthcare Provider Details

I. General information

NPI: 1841470044
Provider Name (Legal Business Name): KRISTEN MARIE TEPER-LACROSSE P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2007
Last Update Date: 11/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35840 CHESTER RD SUITE F
AVON OH
44011-1240
US

IV. Provider business mailing address

35840 CHESTER RD STE F
AVON OH
44011-1240
US

V. Phone/Fax

Practice location:
  • Phone: 440-937-5210
  • Fax: 440-937-5212
Mailing address:
  • Phone: 440-937-5210
  • Fax: 440-937-5212

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number06698
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: