MEDICARE: MRS. ANGELA MARIE CROXFORD MPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT32539	CA

General Provider Information

NPI Number	:	1770685042
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ANGELA MARIE CROXFORD MPT

Provider Business Mailing Address
First Line	:	10562 SENNIT AVE
Second Line	:
City	:	GARDEN GROVE
State	:	CA
Zip	:	92843-5334
Country	:	US
Telephone Number	:	949-307-7622
Fax Number	:	562-596-7214

Provider Business Practice Location Address
First Line	:	6695 E PACIFIC COAST HWY
Second Line	:	SUITE 100
City	:	LONG BEACH
State	:	CA
Zip	:	90803-4235
Country	:	US
Telephone Number	:	562-596-7074
Fax Number	:	562-596-7214

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/05/2006
Last Update Date	:	10/18/2012

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