Provider Demographics
NPI:1518410570
Name:LEHANE, GRETCHEN ANGELIQUE (PT)
Entity Type:Individual
Prefix:MRS
First Name:GRETCHEN
Middle Name:ANGELIQUE
Last Name:LEHANE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4850 TANGLEWOOD CT
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30327-4558
Mailing Address - Country:US
Mailing Address - Phone:770-722-5948
Mailing Address - Fax:
Practice Address - Street 1:4850 TANGLEWOOD CT
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30327-4558
Practice Address - Country:US
Practice Address - Phone:770-722-5948
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-26
Last Update Date:2016-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2670225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist