MEDICARE: LENIS RENEE OBRYAN PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	002090	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000358143	OTHER		ANTHEM
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1851470728
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LENIS RENEE OBRYAN PT

Provider Business Mailing Address
First Line	:	5120 VILLAGE SQUARE DR STE 103
Second Line	:
City	:	PADUCAH
State	:	KY
Zip	:	42001-9560
Country	:	US
Telephone Number	:	502-931-2467
Fax Number	:	270-442-9599

Provider Business Practice Location Address
First Line	:	5120 VILLAGE SQUARE DR STE 103
Second Line	:
City	:	PADUCAH
State	:	KY
Zip	:	42001-9560
Country	:	US
Telephone Number	:	502-931-2467
Fax Number	:	270-442-9599

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/03/2006
Last Update Date	:	04/05/2026

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