Provider Demographics
NPI:1457010647
Name:LEVERENZ, LANCE JOSEPH (DPT)
Entity Type:Individual
Prefix:
First Name:LANCE
Middle Name:JOSEPH
Last Name:LEVERENZ
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:424 N FULLENWIDER ST
Mailing Address - Street 2:
Mailing Address - City:CENTRALIA
Mailing Address - State:MO
Mailing Address - Zip Code:65240-1022
Mailing Address - Country:US
Mailing Address - Phone:573-881-9022
Mailing Address - Fax:
Practice Address - Street 1:1238 REMINGTON DR.
Practice Address - Street 2:
Practice Address - City:CENTRALIA
Practice Address - State:MO
Practice Address - Zip Code:65240
Practice Address - Country:US
Practice Address - Phone:573-682-2230
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-15
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2021021352225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist