Provider Demographics
NPI:1154857233
Name:LENNERT, NATHAN (PT, DPT)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:
Last Name:LENNERT
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 WESTBROOK DR
Mailing Address - Street 2:
Mailing Address - City:CHEEKTOWAGA
Mailing Address - State:NY
Mailing Address - Zip Code:14225-2182
Mailing Address - Country:US
Mailing Address - Phone:716-200-2631
Mailing Address - Fax:
Practice Address - Street 1:29 TAYLOR AVE
Practice Address - Street 2:
Practice Address - City:CROSSVILLE
Practice Address - State:TN
Practice Address - Zip Code:38555-4527
Practice Address - Country:US
Practice Address - Phone:931-456-5757
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-10
Last Update Date:2019-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY040345225100000X
TX1282169225100000X
TN11385225100000X
IN05012277A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist