Healthcare Provider Details

I. General information

NPI: 1871748871
Provider Name (Legal Business Name): LAURA BETH LENHART P.T.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/19/2008
Last Update Date: 11/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

159 W 1ST ST
OSWEGO NY
13126-2045
US

IV. Provider business mailing address

8 STANLEY AVE
OSWEGO NY
13126-6506
US

V. Phone/Fax

Practice location:
  • Phone: 315-342-9575
  • Fax: 315-342-7664
Mailing address:
  • Phone: 315-342-4716
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number004314-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: