Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251S0007X | Physical Therapist - Sports | 63668 | OR |
NPI | 1114535986 |
---|---|
Provider Name | Dr. Zachary Lentini |
First Address | Corvallis, OR 97339-1189 |
Second Address | Corvallis, OR 97331-8629 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2020 |
Last Update Date | 15/01/2021 |