Healthcare Provider Details

I. General information

NPI: 1063583219
Provider Name (Legal Business Name): ANNE MARIE LENICHEK PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

W231S7680 BIG BEND DR
BIG BEND WI
53103-9686
US

IV. Provider business mailing address

W2449 SAINT PETERS RD
EAST TROY WI
53120-1921
US

V. Phone/Fax

Practice location:
  • Phone: 262-662-9760
  • Fax:
Mailing address:
  • Phone: 262-642-2969
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number3529024
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: