Healthcare Provider Details

I. General information

NPI: 1124547641
Provider Name (Legal Business Name): REBECCA LOHRENZ ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2017
Last Update Date: 09/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 W SIERRA MADRE AVE
GLENDORA CA
91741-1955
US

IV. Provider business mailing address

258 HILLSIDE DR
SILVERTHORNE CO
80498-9583
US

V. Phone/Fax

Practice location:
  • Phone: 970-485-3257
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: