Provider Demographics
NPI:1194192583
Name:KANE LONERGAN, ELIZABETH J (DPT)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:J
Last Name:KANE LONERGAN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6400 JEFFERSON ST NE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-3470
Mailing Address - Country:US
Mailing Address - Phone:505-344-2922
Mailing Address - Fax:505-214-5030
Practice Address - Street 1:6400 JEFFERSON ST NE
Practice Address - Street 2:SUITE 102
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-3470
Practice Address - Country:US
Practice Address - Phone:505-344-2922
Practice Address - Fax:505-214-5030
Is Sole Proprietor?:No
Enumeration Date:2015-09-01
Last Update Date:2017-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM4684225100000X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist