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NPI Code Detail

MEDICARE: MR. DINO LAURENZI JR. L-ATC

MEDICARE: MR. DINO LAURENZI JR. L-ATC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12255A2300XAthletic Trainer35WI

General Provider Information

NPI Number : 1699767673
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. DINO LAURENZI JR. L-ATC
Provider Business Mailing Address
First Line : 8005 103RD AVE
Second Line :
City : PLEASANT PRAIRIE
State : WI
Zip : 53158-2050
Country : US
Telephone Number : 262-697-1759
Fax Number :
Provider Business Practice Location Address
First Line : 6308 8TH AVE
Second Line : SUITE 501
City : KENOSHA
State : WI
Zip : 53143-5031
Country : US
Telephone Number : 262-656-3280
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/17/2005
Last Update Date : 07/08/2007

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