Provider Demographics
NPI:1679528137
Name:LEFURGE, LANCE CHARLES (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:MR
First Name:LANCE
Middle Name:CHARLES
Last Name:LEFURGE
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1555 SE DELAWARE AVE
Mailing Address - Street 2:
Mailing Address - City:ANKENY
Mailing Address - State:IA
Mailing Address - Zip Code:50021-4011
Mailing Address - Country:US
Mailing Address - Phone:515-963-8723
Mailing Address - Fax:515-963-8755
Practice Address - Street 1:1555 SE DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50021-4011
Practice Address - Country:US
Practice Address - Phone:515-963-8723
Practice Address - Fax:515-963-8755
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2015-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4926225100000X
IA4169225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAP00606786OtherRR MEDICARE
IAIB3481Medicare PIN
IAI19172058Medicare PIN
IA41530003Medicare PIN
IAI19172Medicare PIN
IAIB3481015Medicare PIN