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General NPI Number Information
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NPI Number | 1194192583
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Entity Type | Individual
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Provider Name | ELIZABETH J KANE LONERGAN DPT
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Gender | Female
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Dates
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Enumeration Date | 09/01/2015
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Last Update Date | 12/27/2017
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Provider Practice Location Address
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Address Line | 6400 JEFFERSON ST NE SUITE 102
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City | ALBUQUERQUE
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State | NM
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Zip | 87109-3470
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Country | US
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Telephone | 505-344-2922
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Fax | 505-214-5030
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Provider Business Mailing Address
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Address Line | 6400 JEFFERSON ST NE SUITE 102
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City | ALBUQUERQUE
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State | NM
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Zip | 87109-3470
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Country | US
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Telephone | 505-344-2922
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Fax | 505-214-5030
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 4684
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | 4684
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License Number State | NM
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