Provider Demographics
NPI:1538702824
Name:CRIDER, VERONICA ANNE (PT)
Entity type:Individual
Prefix:
First Name:VERONICA
Middle Name:ANNE
Last Name:CRIDER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:VERONICA
Other - Middle Name:ANNE
Other - Last Name:LAUE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:PO BOX 31630
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85751-1630
Mailing Address - Country:US
Mailing Address - Phone:520-784-6200
Mailing Address - Fax:520-784-6109
Practice Address - Street 1:2424 N WYATT DR STE 130
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-6119
Practice Address - Country:US
Practice Address - Phone:520-784-6570
Practice Address - Fax:520-784-6575
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-19
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPT-0017182251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ599796Medicaid