Provider Demographics
NPI:1972519569
Name:LAMENS, JOHAN (PT)
Entity type:Individual
Prefix:
First Name:JOHAN
Middle Name:
Last Name:LAMENS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3401 EL CAMINO REAL
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94306-2805
Mailing Address - Country:US
Mailing Address - Phone:650-852-1228
Mailing Address - Fax:650-852-0102
Practice Address - Street 1:3401 EL CAMINO REAL
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94306-2805
Practice Address - Country:US
Practice Address - Phone:650-852-1228
Practice Address - Fax:650-852-0102
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2008-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT1452225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPT145210Medicare PIN