Healthcare Provider Details

I. General information

NPI: 1659889889
Provider Name (Legal Business Name): JAROD LENAHAN MS, LAT, ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/22/2018
Last Update Date: 01/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1115 EAST GETWELL LOOP ST
MEMPHIS TN
38111
US

IV. Provider business mailing address

504 US HIGHWAY 43
WINFIELD AL
35594-4606
US

V. Phone/Fax

Practice location:
  • Phone: 901-678-3536
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number0000002065
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: