Provider Demographics
NPI:1841485190
Name:LENORT, DONALD MARK (MS,PT)
Entity type:Individual
Prefix:MR
First Name:DONALD
Middle Name:MARK
Last Name:LENORT
Suffix:
Gender:M
Credentials:MS,PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9408A MARY GLEN DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63126-2140
Mailing Address - Country:US
Mailing Address - Phone:314-303-0762
Mailing Address - Fax:
Practice Address - Street 1:9408A MARY GLEN DR
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63126-2140
Practice Address - Country:US
Practice Address - Phone:314-303-0762
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-10
Last Update Date:2007-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist