Provider Demographics
NPI:1578702973
Name:LANTZ, LILIANA GABRIELA
Entity Type:Individual
Prefix:
First Name:LILIANA
Middle Name:GABRIELA
Last Name:LANTZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 JEFFERSON BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02888
Mailing Address - Country:US
Mailing Address - Phone:401-463-3060
Mailing Address - Fax:401-463-9990
Practice Address - Street 1:100 JEFFERSON BLVD
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02888-3850
Practice Address - Country:US
Practice Address - Phone:401-463-3060
Practice Address - Fax:401-463-9990
Is Sole Proprietor?:No
Enumeration Date:2009-02-10
Last Update Date:2009-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI02189225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI402251OtherBLUE CHIP
RI64-00223OtherZENILED
RI7542-8OtherBLUE CROSS
RI64-00223OtherZENILED