Provider Demographics
NPI:1487058970
Name:LAURENZI, ANTHONY ROBERT (ATC)
Entity type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:ROBERT
Last Name:LAURENZI
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8005 103RD AVE
Mailing Address - Street 2:
Mailing Address - City:PLEASANT PRAIRIE
Mailing Address - State:WI
Mailing Address - Zip Code:53158-2050
Mailing Address - Country:US
Mailing Address - Phone:262-818-7955
Mailing Address - Fax:
Practice Address - Street 1:8005 103RD AVE
Practice Address - Street 2:
Practice Address - City:PLEASANT PRAIRIE
Practice Address - State:WI
Practice Address - Zip Code:53158-2050
Practice Address - Country:US
Practice Address - Phone:262-818-7955
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-14
Last Update Date:2014-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1469-392255A2300X
OHAT.0041842255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer