Provider Demographics
NPI:1235160193
Name:LENNERS, DOUGLAS D (PT/ATC)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:D
Last Name:LENNERS
Suffix:
Gender:M
Credentials:PT/ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22754 COUNTY ROAD 228
Mailing Address - Street 2:
Mailing Address - City:UNION STAR
Mailing Address - State:MO
Mailing Address - Zip Code:64494-8179
Mailing Address - Country:US
Mailing Address - Phone:660-535-4589
Mailing Address - Fax:816-271-6645
Practice Address - Street 1:801 RIVERSIDE
Practice Address - Street 2:SUITE 250
Practice Address - City:ST. JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64505
Practice Address - Country:US
Practice Address - Phone:816-271-6636
Practice Address - Fax:816-271-6645
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1125362251S0007X
MO20010196572255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
Not Answered2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer