Provider Demographics
NPI:1891775045
Name:LENZ, KELLY J (PT)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:J
Last Name:LENZ
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 1:1836 ASHLEY RIVER RD
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-4781
Mailing Address - Country:US
Mailing Address - Phone:854-202-8371
Mailing Address - Fax:854-900-4102
Practice Address - Street 1:1836 ASHLEY RIVER RD
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-4781
Practice Address - Country:US
Practice Address - Phone:854-202-8371
Practice Address - Fax:854-900-4102
Is Sole Proprietor?:No
Enumeration Date:2006-01-21
Last Update Date:2025-09-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC9802225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3650598Medicaid
TN3650599Medicare ID - Type Unspecified