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General NPI Number Information
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NPI Number | 1003145715
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Entity Type | Individual
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Provider Name | JOSHUA N LACANLALE P.T.
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Gender | Male
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Dates
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Enumeration Date | 12/09/2009
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Last Update Date | 01/03/2022
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Provider Practice Location Address
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Address Line | 3035 S ELLSWORTH RD BLDG 4, #128
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City | MESA
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State | AZ
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Zip | 85212-2160
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Country | US
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Telephone | 480-357-6500
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Fax | 480-357-6515
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Provider Business Mailing Address
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Address Line | PO BOX 32490
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City | PHOENIX
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State | AZ
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Zip | 85064-2490
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Country | US
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Telephone | 602-230-4478
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Fax | 602-230-9962
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | 8754
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License Number State | AZ
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