Basic Information
| Provider Information | |||||||||
| NPI: | 1184047078 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LENGEL | ||||||||
| FirstName: | VICTORIA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | PTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2003 S JEFFERSON PKWY | ||||||||
| Address2: | |||||||||
| City: | HARRISONVILLE | ||||||||
| State: | MO | ||||||||
| PostalCode: | 647013714 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8163804731 | ||||||||
| FaxNumber: | 8163804989 | ||||||||
| Practice Location | |||||||||
| Address1: | 2003 S JEFFERSON PKWY | ||||||||
| Address2: | |||||||||
| City: | HARRISONVILLE | ||||||||
| State: | MO | ||||||||
| PostalCode: | 647013714 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8163804731 | ||||||||
| FaxNumber: | 8163804989 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/28/2014 | ||||||||
| LastUpdateDate: | 01/28/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | 2001018670 | MO | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.