Provider Demographics
NPI:1407234693
Name:LORANCE, BRIAN (ATC)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:
Last Name:LORANCE
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 E 14TH ST
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:OK
Mailing Address - Zip Code:74820-6915
Mailing Address - Country:US
Mailing Address - Phone:580-559-5315
Mailing Address - Fax:580-332-8361
Practice Address - Street 1:1100 E. 14ST.
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:OK
Practice Address - Zip Code:74820
Practice Address - Country:US
Practice Address - Phone:580-559-5315
Practice Address - Fax:580-332-8361
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-08
Last Update Date:2015-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5352255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer