Provider Demographics
NPI:1194833665
Name:VANCZA, LORI JANE (LAT,ATC)
Entity Type:Individual
Prefix:MS
First Name:LORI
Middle Name:JANE
Last Name:VANCZA
Suffix:
Gender:F
Credentials:LAT,ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1802 COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47803-4033
Mailing Address - Country:US
Mailing Address - Phone:812-235-6299
Mailing Address - Fax:
Practice Address - Street 1:401 N 4TH ST
Practice Address - Street 2:HHP BLDG RM B-17
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47809-1934
Practice Address - Country:US
Practice Address - Phone:812-237-4062
Practice Address - Fax:812-237-9612
Is Sole Proprietor?:No
Enumeration Date:2006-08-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN36000226A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer