Basic Information
Provider Information
NPI: 1003138751
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: LENTZ
FirstName: LORI
MiddleName: ENDERS
NamePrefix: MS.
NameSuffix:  
Credential: PT
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 6582 WOODEN SHOE DR
Address2:  
City: LIBERTY TOWNSHIP
State: OH
PostalCode: 450449156
CountryCode: US
TelephoneNumber: 5137559801
FaxNumber:  
Practice Location
Address1: 6582 WOODEN SHOE DR
Address2:  
City: LIBERTY TOWNSHIP
State: OH
PostalCode: 450449156
CountryCode: US
TelephoneNumber: 5137559801
FaxNumber:  
Other Information
ProviderEnumerationDate: 02/23/2010
LastUpdateDate: 04/15/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225100000XOH - PT4201OHN Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 
2251N0400XOH - PT4201OHY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurology

No ID Information.


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