Healthcare Provider Details

I. General information

NPI: 1053292326
Provider Name (Legal Business Name): MARK LAFRENZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2025
Last Update Date: 09/11/2025
Certification Date: 09/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6325 ROCKWELL DR NE
CEDAR RAPIDS IA
52402-7203
US

IV. Provider business mailing address

6731 W 121ST ST STE 100
OVERLAND PARK KS
66209-2003
US

V. Phone/Fax

Practice location:
  • Phone: 319-594-0883
  • Fax:
Mailing address:
  • Phone: 319-594-0883
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number078591
License Number StateIA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: