Provider Demographics
NPI:1093119117
Name:LENZ, MARTIN G (MSPT)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:G
Last Name:LENZ
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6735 HARBISON AVENUE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19149-2305
Mailing Address - Country:US
Mailing Address - Phone:215-725-2000
Mailing Address - Fax:
Practice Address - Street 1:3300 GRANT AVE
Practice Address - Street 2:UNIT 19C
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19114-2614
Practice Address - Country:US
Practice Address - Phone:215-754-8743
Practice Address - Fax:215-754-4450
Is Sole Proprietor?:No
Enumeration Date:2014-10-17
Last Update Date:2020-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT023235225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist