Provider Demographics
NPI:1114521473
Name:CALAI, LAURENCIA (DPT)
Entity Type:Individual
Prefix:
First Name:LAURENCIA
Middle Name:
Last Name:CALAI
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:LAURENCIA
Other - Middle Name:
Other - Last Name:CANZONETTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1932 NILES CORTLAND RD NE STE T
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44484-1055
Mailing Address - Country:US
Mailing Address - Phone:330-856-1520
Mailing Address - Fax:330-856-7342
Practice Address - Street 1:1932 NILES CORTLAND RD NE STE T
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44484-1055
Practice Address - Country:US
Practice Address - Phone:330-856-1520
Practice Address - Fax:330-856-7342
Is Sole Proprietor?:No
Enumeration Date:2020-11-27
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT018983225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0425910Medicaid