Provider Demographics
NPI:1770643801
Name:LENZ, MARICIA G (PT)
Entity Type:Individual
Prefix:MS
First Name:MARICIA
Middle Name:G
Last Name:LENZ
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 1:36 ROYAL RD
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-5824
Mailing Address - Country:US
Mailing Address - Phone:207-947-2950
Mailing Address - Fax:207-992-2154
Practice Address - Street 1:30 SUMMER ST
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-6467
Practice Address - Country:US
Practice Address - Phone:207-992-2457
Practice Address - Fax:207-992-2154
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT2394225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEPT2394OtherLICENSE NUMBER