Provider Demographics
NPI:1740569425
Name:LENTZ, JESSICA MARIE (DPT, LAT, ATC)
Entity type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:MARIE
Last Name:LENTZ
Suffix:
Gender:F
Credentials:DPT, LAT, ATC
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:SCHREPPEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7 DOCK HILL RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17842-8910
Mailing Address - Country:US
Mailing Address - Phone:570-837-2123
Mailing Address - Fax:570-837-2185
Practice Address - Street 1:36 S RIVER RD UNIT 2
Practice Address - Street 2:
Practice Address - City:HALIFAX
Practice Address - State:PA
Practice Address - Zip Code:17032-8614
Practice Address - Country:US
Practice Address - Phone:717-827-3306
Practice Address - Fax:717-827-3292
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-11
Last Update Date:2019-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART0047412255A2300X
PAPT024610225100000X
PADAPT003840225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1030464630001Medicaid