Individual
JACOB J LENTHALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT, DPT, ATC
Contact information
Practice address
30 GLENNIE ST, WORCESTER, MA 01605-3917
(508) 791-8740
(508) 752-3716
Mailing address
30 GLENNIE ST, WORCESTER, MA 01605-3917
(508) 791-8740
(508) 752-3716
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
24997
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
24997
STATE LICENSE
MA
Enumeration date
08/07/2020
Last updated
08/07/2020
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