Provider Demographics
NPI:1033863121
Name:LENZ, LAUREN (DPT)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:LENZ
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7240 COUNTY ROAD MM
Mailing Address - Street 2:
Mailing Address - City:LARSEN
Mailing Address - State:WI
Mailing Address - Zip Code:54947-9505
Mailing Address - Country:US
Mailing Address - Phone:715-891-1100
Mailing Address - Fax:
Practice Address - Street 1:2901 E ENTERPRISE AVE STE 600
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54913-7401
Practice Address - Country:US
Practice Address - Phone:920-738-0671
Practice Address - Fax:920-738-0773
Is Sole Proprietor?:No
Enumeration Date:2022-02-08
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15701-24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100204327Medicaid