=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881844702
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LORENZO MASTRANGELO R.P.T.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/27/2008
-----------------------------------------------------
Last Update Date | 09/27/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 23 PROSPECT AVE
-----------------------------------------------------
City | NORWALK
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06850-3705
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-857-4605
-----------------------------------------------------
Fax | 203-857-4605
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 266 MAIN AVE APT. 6
-----------------------------------------------------
City | NORWALK
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06851-6126
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-840-1582
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 004855
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------