Healthcare Provider Details

I. General information

NPI: 1700893401
Provider Name (Legal Business Name): RENEE LENCESKI DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 S MAIN ST
OLD FORGE PA
18518
US

IV. Provider business mailing address

101 MICHELINE DR
OLD FORGE PA
18518-2359
US

V. Phone/Fax

Practice location:
  • Phone: 570-457-4099
  • Fax: 570-457-7205
Mailing address:
  • Phone: 570-457-0884
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT016563
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1786782
Identifier TypeOTHER
Identifier State
Identifier IssuerHIGHMARK BLUE SHIELD
# 2
Identifier9412543
Identifier TypeOTHER
Identifier State
Identifier IssuerCIGNA
# 3
Identifier819843
Identifier TypeOTHER
Identifier State
Identifier IssuerFIRST PRIORITY HEALTH
# 4
Identifier416843
Identifier TypeOTHER
Identifier State
Identifier IssuerHEALTH AMERICA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: