Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2251S0007X | Physical Therapist - Sports | 112536 | MO |
NPI | 1235160193 |
---|---|
Provider Name | Douglas D Lenners |
First Address | Union Star, MO 64494-8179 |
Second Address | St. Joseph, MO 64505 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/07/2006 |
Last Update Date | 08/07/2007 |