Provider Demographics
NPI:1174849491
Name:TOLENTINO, LORENZO ANTONIO AQUINO
Entity Type:Individual
Prefix:MR
First Name:LORENZO ANTONIO
Middle Name:AQUINO
Last Name:TOLENTINO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 KATE DRIVE
Mailing Address - Street 2:
Mailing Address - City:SIKESTON
Mailing Address - State:MO
Mailing Address - Zip Code:63801
Mailing Address - Country:US
Mailing Address - Phone:573-258-9545
Mailing Address - Fax:573-748-2412
Practice Address - Street 1:1050 DAWSON ROAD
Practice Address - Street 2:
Practice Address - City:NEW MADRID
Practice Address - State:MO
Practice Address - Zip Code:63869
Practice Address - Country:US
Practice Address - Phone:573-748-5622
Practice Address - Fax:573-748-2412
Is Sole Proprietor?:No
Enumeration Date:2010-04-12
Last Update Date:2010-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008036169225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist