Provider Demographics
NPI:1417910944
Name:MCCLOSKEY, LIDA CHRISTINE (LAT)
Entity Type:Individual
Prefix:MRS
First Name:LIDA
Middle Name:CHRISTINE
Last Name:MCCLOSKEY
Suffix:
Gender:F
Credentials:LAT
Other - Prefix:
Other - First Name:LIDA
Other - Middle Name:CHRISTINE
Other - Last Name:ALBRIGHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAT
Mailing Address - Street 1:PO BOX 146
Mailing Address - Street 2:
Mailing Address - City:IRAAN
Mailing Address - State:TX
Mailing Address - Zip Code:79744-0146
Mailing Address - Country:US
Mailing Address - Phone:432-639-6087
Mailing Address - Fax:
Practice Address - Street 1:100 S FARR ST.
Practice Address - Street 2:
Practice Address - City:IRAAN
Practice Address - State:TX
Practice Address - Zip Code:79744
Practice Address - Country:US
Practice Address - Phone:432-639-2512
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT29392255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer