Provider Demographics
NPI:1558663476
Name:BIENZ, LANA SUE (MPT)
Entity Type:Individual
Prefix:
First Name:LANA
Middle Name:SUE
Last Name:BIENZ
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:LANA
Other - Middle Name:SUE
Other - Last Name:BLOCHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:2918 GLENCAIRN DR
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46815-6716
Mailing Address - Country:US
Mailing Address - Phone:260-426-5431
Mailing Address - Fax:260-421-1821
Practice Address - Street 1:2121 LAKE AVE
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46805-5100
Practice Address - Country:US
Practice Address - Phone:260-426-5431
Practice Address - Fax:260-426-5431
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-29
Last Update Date:2010-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05008054A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist