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Individual

MR. JONATHAN DAVID LENZE

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
ATC, LAT

Contact information

Practice address
3201 E COURT ST, CONSUMERS ENERGY WELLNESS ROOM, FLINT, MI 48506-4022
(810) 760-3484
(810) 760-3329
Mailing address
36296 FREDERICKSBURG RD, FARMINGTON HILLS, MI 48331-3189
(810) 760-3484

Taxonomy

Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
1043
SC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
040802004
NATIONAL ATHLETIC TRAINERS ASSOCIATION
01
1043
STATE OF SOUTH CAROLINA DEPARTMENT OF HEALTH AND ENVIRONMENTAL CONTROL
SC
01
2601001137
STATE OF MICHIGAN DEPARTMENT OF LICENSING AND REGULATORY AFFAIRS
MI
Enumeration date
04/30/2009
Last updated
06/06/2013
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