Provider Demographics
NPI:1194792176
Name:LENKAUSKAS, JENNIFER (PT)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:
Last Name:LENKAUSKAS
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 1:319A SOUTHBRIDGE STREET
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01501-2568
Mailing Address - Country:US
Mailing Address - Phone:508-832-2628
Mailing Address - Fax:508-832-7824
Practice Address - Street 1:154 E MAIN ST
Practice Address - Street 2:
Practice Address - City:WESTBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01581-1768
Practice Address - Country:US
Practice Address - Phone:508-366-7899
Practice Address - Fax:508-366-9819
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2011-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA11934225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA57295OtherFALLON
MDY68100OtherBLUE SHIELD
MA0398811Medicaid
MA469903OtherTUFTS
MAY69000Medicare ID - Type Unspecified