Provider Demographics
NPI:1225184773
Name:LENTZ, TERRY DELL (RN, LMP)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:DELL
Last Name:LENTZ
Suffix:
Gender:F
Credentials:RN, LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7435 159TH PL NE APT A208
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-4381
Mailing Address - Country:US
Mailing Address - Phone:425-869-8033
Mailing Address - Fax:
Practice Address - Street 1:16250 NE 80TH ST
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-3821
Practice Address - Country:US
Practice Address - Phone:425-867-1119
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00010176225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist