Basic Information
| Provider Information | |||||||||
| NPI: | 1609829571 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | ALLEE | ||||||||
| FirstName: | LANCE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10836 ROCKY MOUNTAIN DR NW | ||||||||
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| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871143565 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5057922325 | ||||||||
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| Practice Location | |||||||||
| Address1: | 8814 HORIZON BLVD NE | ||||||||
| Address2: | |||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871131689 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5058282400 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/19/2006 | ||||||||
| LastUpdateDate: | 06/17/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 3207 | NM | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | 361183-2401 | UT | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 003402632 | 05 | NV | MEDICAID |