Provider Demographics
NPI:1497135313
Name:LORRIG, BRANDON (ATC, LAT)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:
Last Name:LORRIG
Suffix:
Gender:M
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:730 10TH AVE
Mailing Address - Street 2:
Mailing Address - City:BALDWIN
Mailing Address - State:WI
Mailing Address - Zip Code:54002-9416
Mailing Address - Country:US
Mailing Address - Phone:715-684-8680
Mailing Address - Fax:715-684-3501
Practice Address - Street 1:730 10TH AVE
Practice Address - Street 2:
Practice Address - City:BALDWIN
Practice Address - State:WI
Practice Address - Zip Code:54002-9416
Practice Address - Country:US
Practice Address - Phone:715-684-8680
Practice Address - Fax:715-684-3501
Is Sole Proprietor?:No
Enumeration Date:2015-06-05
Last Update Date:2015-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1628-392255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer