Provider Demographics
NPI:1720222003
Name:LENZE, JONATHAN DAVID (ATC, LAT)
Entity Type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:DAVID
Last Name:LENZE
Suffix:
Gender:M
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:36296 FREDERICKSBURG RD
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48331-3189
Mailing Address - Country:US
Mailing Address - Phone:810-760-3484
Mailing Address - Fax:
Practice Address - Street 1:3201 E COURT ST
Practice Address - Street 2:CONSUMERS ENERGY WELLNESS ROOM
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48506-4022
Practice Address - Country:US
Practice Address - Phone:810-760-3484
Practice Address - Fax:810-760-3329
Is Sole Proprietor?:No
Enumeration Date:2009-04-30
Last Update Date:2013-06-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC10432255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
040802004OtherNATIONAL ATHLETIC TRAINERS ASSOCIATION
MI2601001137OtherSTATE OF MICHIGAN DEPARTMENT OF LICENSING AND REGULATORY AFFAIRS
SC1043OtherSTATE OF SOUTH CAROLINA DEPARTMENT OF HEALTH AND ENVIRONMENTAL CONTROL