Provider Demographics
NPI:1073036398
Name:COMPLETE ORTHOPEDIC AND SPORTS THERAPY LLC
Entity Type:Organization
Organization Name:COMPLETE ORTHOPEDIC AND SPORTS THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LUKAS
Authorized Official - Middle Name:
Authorized Official - Last Name:DELORENZO
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:412-480-5640
Mailing Address - Street 1:516 GLENMERE AVE
Mailing Address - Street 2:
Mailing Address - City:NEPTUNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07753-5611
Mailing Address - Country:US
Mailing Address - Phone:412-480-5640
Mailing Address - Fax:
Practice Address - Street 1:63 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:MANASQUAN
Practice Address - State:NJ
Practice Address - Zip Code:08736-2926
Practice Address - Country:US
Practice Address - Phone:412-480-5640
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-18
Last Update Date:2017-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty