Individual provider Active NPI

Nicole Victoria Lennon, PT, DPT

  • Physical Therapist
  • San Antonio, TX
National Provider Identifier
1881463818
Registry record updated Nov 22, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
1365935 Issued in TX
Practice address
14114 Oak CT
San Antonio, TX 78232-4924
Phone
(210) 415-2627
NPI assigned
Jan 2, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 22, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 1365935 TX Primary

Addresses

Primary practice location

14114 Oak CT
San Antonio, TX 78232-4924

Mailing address

14114 Oak CT
San Antonio, TX 78232-4924
Phone (210) 415-2627

Other practice location 1

8230 N Loop 1604 W Ste 201
San Antonio, TX 78249-2991
Phone (210) 423-3711

Other identifiers 1

IdentifierTypeStateIssuer
1365935OtherTXSTATE LICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240419000504 TX Practitioner - Physical Therapist in Private Practice 4385083674 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Texas Luna Care Physical Therapy LLCGroup PAC ID 0648692723, 271 clinicians

Practice addresses (Care Compare)

180 State St
Suite 225
Southlake, TX 76092-7632
Phone (866) 525-3175

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
1365935TXMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Texas Luna Care Physical Therapy LLC Physical Therapist CurrentSince Dec 4, 2025 Accepting new patients

Locations

180 State St
Ste 225
Southlake, TX 76092
Phone (682) 429-7066

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1704153600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1763769600000",
    "number": "1881463818",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14114 OAK CT",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782324924",
            "telephone_number": "210-415-2627"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14114 OAK CT",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782324924",
            "telephone_number": "210-415-2627"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8230 N Loop 1604 W Ste 201",
            "address_purpose": "LOCATION",
            "city": "San Antonio",
            "state": "TX",
            "postal_code": "782492991",
            "country_code": "US",
            "telephone_number": "210-423-3711",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LENNON",
        "first_name": "NICOLE",
        "middle_name": "VICTORIA",
        "credential": "PT, DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-01-02",
        "last_updated": "2025-11-22",
        "certification_date": "2025-11-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "TX",
            "license": "1365935",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "1365935",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in San Antonio, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 22, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.