Provider Demographics
NPI:1336427269
Name:LENZE, GINGER MICHELLE (LMT)
Entity type:Individual
Prefix:MRS
First Name:GINGER
Middle Name:MICHELLE
Last Name:LENZE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13405 BRIGHTSTRAW LN
Mailing Address - Street 2:
Mailing Address - City:ASTATULA
Mailing Address - State:FL
Mailing Address - Zip Code:34705-9313
Mailing Address - Country:US
Mailing Address - Phone:352-516-3970
Mailing Address - Fax:
Practice Address - Street 1:13405 BRIGHTSTRAW LN
Practice Address - Street 2:
Practice Address - City:ASTATULA
Practice Address - State:FL
Practice Address - Zip Code:34705-9313
Practice Address - Country:US
Practice Address - Phone:352-516-3970
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-26
Last Update Date:2011-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA38417225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist