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General NPI Number Information
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NPI Number | 1649780834
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Entity Type | Individual
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Provider Name | DILLON LESNIAK
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Gender | Male
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Dates
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Enumeration Date | 10/03/2017
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Last Update Date | 01/06/2019
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Provider Practice Location Address
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Address Line | 1971 UNIVERSITY BLVD
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City | LYNCHBURG
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State | VA
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Zip | 24515-4267
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Country | US
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Telephone | 262-366-3503
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Fax |
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Provider Business Mailing Address
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Address Line | W303N3211 TIMBER HILL CT
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City | PEWAUKEE
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State | WI
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Zip | 53072-4267
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 0126003064
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License Number State | VA
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