Provider Demographics
NPI:1053576850
Name:LACROIX, HEIDI MARLENE (PTA)
Entity type:Individual
Prefix:MS
First Name:HEIDI
Middle Name:MARLENE
Last Name:LACROIX
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 WAKE ROBIN DR
Mailing Address - Street 2:
Mailing Address - City:SHELBURNE
Mailing Address - State:VT
Mailing Address - Zip Code:05482-7569
Mailing Address - Country:US
Mailing Address - Phone:802-264-5140
Mailing Address - Fax:802-264-5152
Practice Address - Street 1:200 WAKE ROBIN DR
Practice Address - Street 2:
Practice Address - City:SHELBURNE
Practice Address - State:VT
Practice Address - Zip Code:05482-7569
Practice Address - Country:US
Practice Address - Phone:802-264-5140
Practice Address - Fax:802-264-5152
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-22
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT041-000294225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant