Provider Demographics
NPI:1508179474
Name:LAURENTZ, JENNIFER L (DPT, OCS)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:LAURENTZ
Suffix:
Gender:F
Credentials:DPT, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 PLANTATION DR STE 100A
Mailing Address - Street 2:
Mailing Address - City:CAMERON
Mailing Address - State:NC
Mailing Address - Zip Code:28326-9430
Mailing Address - Country:US
Mailing Address - Phone:910-436-1021
Mailing Address - Fax:
Practice Address - Street 1:2065 AIRPORT BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-5931
Practice Address - Country:US
Practice Address - Phone:850-477-6966
Practice Address - Fax:850-477-0267
Is Sole Proprietor?:No
Enumeration Date:2010-07-21
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL25678225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist