Provider Demographics
NPI:1912462730
Name:DEVONTENNO, LITHANY (MS, LAT, ATC)
Entity type:Individual
Prefix:
First Name:LITHANY
Middle Name:
Last Name:DEVONTENNO
Suffix:
Gender:F
Credentials:MS, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4710 N 5TH ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-1738
Mailing Address - Country:US
Mailing Address - Phone:505-410-6848
Mailing Address - Fax:
Practice Address - Street 1:4710 N 5TH ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012-1738
Practice Address - Country:US
Practice Address - Phone:505-410-6848
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-06
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer