Provider Demographics
NPI:1700893401
Name:LENCESKI, RENEE (DPT)
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:
Last Name:LENCESKI
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 MICHELINE DR
Mailing Address - Street 2:
Mailing Address - City:OLD FORGE
Mailing Address - State:PA
Mailing Address - Zip Code:18518-2359
Mailing Address - Country:US
Mailing Address - Phone:570-457-0884
Mailing Address - Fax:
Practice Address - Street 1:501 S MAIN ST
Practice Address - Street 2:
Practice Address - City:OLD FORGE
Practice Address - State:PA
Practice Address - Zip Code:18518
Practice Address - Country:US
Practice Address - Phone:570-457-4099
Practice Address - Fax:570-457-7205
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT016563225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1786782OtherHIGHMARK BLUE SHIELD
9412543OtherCIGNA
819843OtherFIRST PRIORITY HEALTH
416843OtherHEALTH AMERICA
098855Q69Medicare ID - Type Unspecified