Provider Demographics
NPI: | 1801180583 |
---|---|
Name: | LOZANO, TERESA (PT/OTR) |
Entity Type: | Individual |
Prefix: | MS |
First Name: | TERESA |
Middle Name: | |
Last Name: | LOZANO |
Suffix: | |
Gender: | F |
Credentials: | PT/OTR |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 2029 RAVENWOOD LN |
Mailing Address - Street 2: | |
Mailing Address - City: | HARLINGEN |
Mailing Address - State: | TX |
Mailing Address - Zip Code: | 78550-7857 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 956-536-9024 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 702 N ED CAREY DR |
Practice Address - Street 2: | |
Practice Address - City: | HARLINGEN |
Practice Address - State: | TX |
Practice Address - Zip Code: | 78550-7914 |
Practice Address - Country: | US |
Practice Address - Phone: | 956-440-1155 |
Practice Address - Fax: | 956-440-0913 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2011-05-31 |
Last Update Date: | 2011-05-31 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
UT | 1028512 | 225100000X |
TX | 1028512 | 2251N0400X, 2251P0200X, 2251S0007X, 2251X0800X |
UT | 112446 | 225X00000X |
TX | 112446 | 225XG0600X, 225XN1300X, 225XP0019X, 225XP0200X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 2251P0200X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Pediatrics |
No | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | |
No | 2251N0400X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Neurology |
No | 2251S0007X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Sports |
No | 2251X0800X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Orthopedic |
No | 225X00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | |
No | 225XG0600X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Gerontology |
No | 225XN1300X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Neurorehabilitation |
No | 225XP0019X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Physical Rehabilitation |
No | 225XP0200X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Pediatrics |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
TX | 154838001 | Medicaid |