Basic Information
| Provider Information | |||||||||
| NPI: | 1780315788 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NOBLEZA | ||||||||
| FirstName: | LANIE | ||||||||
| MiddleName: | DAMIAN | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2101 N 23RD ST | ||||||||
| Address2: | |||||||||
| City: | MCALLEN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 785016127 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9566874559 | ||||||||
| FaxNumber: | 9566181342 | ||||||||
| Practice Location | |||||||||
| Address1: | 1317 ST CLAIRE BLVD STE A | ||||||||
| Address2: | |||||||||
| City: | MISSION | ||||||||
| State: | TX | ||||||||
| PostalCode: | 785726636 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9566874559 | ||||||||
| FaxNumber: | 9566181342 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/21/2022 | ||||||||
| LastUpdateDate: | 06/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/21/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 1277880 | TX | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.