Provider Demographics
NPI:1528687118
Name:LENNANDER, MARIAH A (PTA)
Entity type:Individual
Prefix:MISS
First Name:MARIAH
Middle Name:A
Last Name:LENNANDER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 FRANKLIN ST SW
Mailing Address - Street 2:
Mailing Address - City:HUTCHINSON
Mailing Address - State:MN
Mailing Address - Zip Code:55350-3101
Mailing Address - Country:US
Mailing Address - Phone:218-289-5095
Mailing Address - Fax:
Practice Address - Street 1:805 FRANKLIN ST SW
Practice Address - Street 2:
Practice Address - City:HUTCHINSON
Practice Address - State:MN
Practice Address - Zip Code:55350-3101
Practice Address - Country:US
Practice Address - Phone:218-289-5095
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-13
Last Update Date:2020-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNA2499225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant