Provider Demographics
NPI:1780315788
Name:NOBLEZA, LANIE DAMIAN (PT)
Entity type:Individual
Prefix:
First Name:LANIE
Middle Name:DAMIAN
Last Name:NOBLEZA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 N 23RD ST
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78501-6127
Mailing Address - Country:US
Mailing Address - Phone:956-687-4559
Mailing Address - Fax:956-618-1342
Practice Address - Street 1:1317 ST CLAIRE BLVD STE A
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-6636
Practice Address - Country:US
Practice Address - Phone:956-687-4559
Practice Address - Fax:956-618-1342
Is Sole Proprietor?:No
Enumeration Date:2022-06-21
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1277880225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist