Provider Demographics
NPI:1326076175
Name:LORENZ, BRANDON (PT)
Entity Type:Individual
Prefix:MR
First Name:BRANDON
Middle Name:
Last Name:LORENZ
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3145 W CLARK RD
Mailing Address - Street 2:STE 106
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-1120
Mailing Address - Country:US
Mailing Address - Phone:734-528-9760
Mailing Address - Fax:734-829-0173
Practice Address - Street 1:2058 S STATE ST
Practice Address - Street 2:STE 500
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-4786
Practice Address - Country:US
Practice Address - Phone:734-913-0300
Practice Address - Fax:734-913-0400
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501011342225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P09920Medicare PIN
MIP09920002Medicare ID - Type Unspecified