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General NPI Number Information
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NPI Number | 1609056746
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Entity Type | Individual
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Provider Name | VICKY LEE LIGHTFOOT P.T.A.
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Gender | Female
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Dates
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Enumeration Date | 11/06/2007
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Last Update Date | 11/06/2007
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Provider Practice Location Address
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Address Line | 15802 N PARKVIEW PL
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City | SURPRISE
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State | AZ
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Zip | 85374-7466
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Country | US
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Telephone | 623-876-7000
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Fax |
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Provider Business Mailing Address
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Address Line | 4410 W DAHLIA DR
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City | GLENDALE
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State | AZ
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Zip | 85304-2138
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Country | US
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Telephone | 602-595-2365
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Fax |
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 6185A
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License Number State | AZ
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