Provider Demographics
NPI:1073129417
Name:NOWATZKI, LANAE (ATC)
Entity type:Individual
Prefix:
First Name:LANAE
Middle Name:
Last Name:NOWATZKI
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:LANAE
Other - Middle Name:
Other - Last Name:GAYLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATC
Mailing Address - Street 1:3300 W CAMELBACK RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85017-1097
Mailing Address - Country:US
Mailing Address - Phone:602-639-7200
Mailing Address - Fax:
Practice Address - Street 1:3300 W CAMELBACK RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85017-1097
Practice Address - Country:US
Practice Address - Phone:541-914-4701
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-21
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZATR-0090642255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer