MEDICARE: ASHLEY DANIELLE LENZEN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2081S0010X	Sports Medicine (Physical Medicine & Rehabilitation) Physician	PTA24241	FL

General Provider Information

NPI Number	:	1316723380
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY DANIELLE LENZEN

Provider Business Mailing Address
First Line	:	2884 WELLNESS AVE
Second Line	:
City	:	ORANGE CITY
State	:	FL
Zip	:	32763-8426
Country	:	US
Telephone Number	:	386-774-4404
Fax Number	:

Provider Business Practice Location Address
First Line	:	2884 WELLNESS AVE
Second Line	:
City	:	ORANGE CITY
State	:	FL
Zip	:	32763-8426
Country	:	US
Telephone Number	:	386-774-4404
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/06/2023
Last Update Date	:	09/06/2023

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Directions to “ ASHLEY DANIELLE LENZEN ” Practice Location

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