Provider Demographics
NPI:1760679419
Name:LENFESTEY, MATTHEW C (MPT)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:C
Last Name:LENFESTEY
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 GREENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:WINTHROP
Mailing Address - State:ME
Mailing Address - Zip Code:04364-1551
Mailing Address - Country:US
Mailing Address - Phone:207-377-8505
Mailing Address - Fax:
Practice Address - Street 1:77 GREENWOOD AVE
Practice Address - Street 2:
Practice Address - City:WINTHROP
Practice Address - State:ME
Practice Address - Zip Code:04364-1551
Practice Address - Country:US
Practice Address - Phone:207-377-8505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-26
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT2503225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist