Provider Demographics
NPI:1619964582
Name:LECHTENBERG, RODNEY THOMAS JR (ATC, LAT)
Entity Type:Individual
Prefix:MR
First Name:RODNEY
Middle Name:THOMAS
Last Name:LECHTENBERG
Suffix:JR
Gender:M
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1530 REDWOOD PL
Mailing Address - Street 2:
Mailing Address - City:TAHLEQUAH
Mailing Address - State:OK
Mailing Address - Zip Code:74464-6050
Mailing Address - Country:US
Mailing Address - Phone:915-276-5711
Mailing Address - Fax:
Practice Address - Street 1:603 N GRAND AVE
Practice Address - Street 2:
Practice Address - City:TAHLEQUAH
Practice Address - State:OK
Practice Address - Zip Code:74464-2302
Practice Address - Country:US
Practice Address - Phone:915-276-5711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-05
Last Update Date:2016-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT32822255A2300X
OK8672255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer