Provider Demographics
NPI:1447285861
Name:LENTZ, BECKI JO (PT)
Entity type:Individual
Prefix:MRS
First Name:BECKI
Middle Name:JO
Last Name:LENTZ
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9052 11 MILE RD
Mailing Address - Street 2:
Mailing Address - City:MECOSTA
Mailing Address - State:MI
Mailing Address - Zip Code:49332
Mailing Address - Country:US
Mailing Address - Phone:231-972-8289
Mailing Address - Fax:231-972-7981
Practice Address - Street 1:9052 11 MILE RD
Practice Address - Street 2:
Practice Address - City:MECOSTA
Practice Address - State:MI
Practice Address - Zip Code:49332
Practice Address - Country:US
Practice Address - Phone:231-972-8289
Practice Address - Fax:231-972-7981
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501006244225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
0N38100Medicare ID - Type Unspecified