Healthcare Provider Details

I. General information

NPI: 1396656435
Provider Name (Legal Business Name): JESSICA LORENZ PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 GENEVA PKWY N
LAKE GENEVA WI
53147-4594
US

IV. Provider business mailing address

776 TRUMAN ST
OREGON WI
53575-2847
US

V. Phone/Fax

Practice location:
  • Phone: 262-249-3500
  • Fax:
Mailing address:
  • Phone: 608-220-8811
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number17900-24
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: