=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598828089
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANITA LENDACH PT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/18/2006
-----------------------------------------------------
Last Update Date | 01/18/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 475 HILL ST STE C
-----------------------------------------------------
City | RENO
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89501-1816
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 775-870-1511
-----------------------------------------------------
Fax | 310-388-3111
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 475 HILL ST STE C
-----------------------------------------------------
City | RENO
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89501-1816
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 775-870-1511
-----------------------------------------------------
Fax | 310-388-3111
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | PT30134
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------