Provider Demographics
NPI:1295865525
Name:DILORENZO, LEO (LMP)
Entity Type:Individual
Prefix:
First Name:LEO
Middle Name:
Last Name:DILORENZO
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 3RD AVE STE 450
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-3000
Mailing Address - Country:US
Mailing Address - Phone:206-447-2220
Mailing Address - Fax:206-447-2228
Practice Address - Street 1:1201 3RD AVE STE 450
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-3000
Practice Address - Country:US
Practice Address - Phone:206-447-2220
Practice Address - Fax:206-447-2228
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00019707225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1073674388OtherGROUP NPI NUMBER
WA162840OtherGROUP L&I NUMBER
WA194287OtherINDIVIDUAL L&I NUMBER