Provider Demographics
NPI:1891970273
Name:LENZ, AMY JANE
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:JANE
Last Name:LENZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 SE MACY RD
Mailing Address - Street 2:STE 12
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-7841
Mailing Address - Country:US
Mailing Address - Phone:479-271-6556
Mailing Address - Fax:479-271-6558
Practice Address - Street 1:3400 SE MACY RD
Practice Address - Street 2:STE 12
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-7841
Practice Address - Country:US
Practice Address - Phone:479-271-6556
Practice Address - Fax:479-271-6558
Is Sole Proprietor?:No
Enumeration Date:2008-01-04
Last Update Date:2008-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR3982255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer