Provider Demographics
NPI:1881463818
Name:LENNON, NICOLE VICTORIA (PT, DPT)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:VICTORIA
Last Name:LENNON
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14114 OAK CT
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232-4924
Mailing Address - Country:US
Mailing Address - Phone:210-415-2627
Mailing Address - Fax:
Practice Address - Street 1:14114 OAK CT
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78232-4924
Practice Address - Country:US
Practice Address - Phone:210-415-2627
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-02
Last Update Date:2025-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1365935225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1365935OtherSTATE LICENSE