Provider Demographics
NPI:1528567948
Name:LORENZ, CARRIE JEANTEAL (MT)
Entity Type:Individual
Prefix:MS
First Name:CARRIE
Middle Name:JEANTEAL
Last Name:LORENZ
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1118 OUTLET COLLECTION WAY SW STE 101
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98001-6569
Mailing Address - Country:US
Mailing Address - Phone:253-269-0261
Mailing Address - Fax:253-269-0202
Practice Address - Street 1:1118 OUTLET COLLECTION WAY SW STE 101
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98001-6569
Practice Address - Country:US
Practice Address - Phone:253-269-0261
Practice Address - Fax:253-269-0202
Is Sole Proprietor?:No
Enumeration Date:2018-02-12
Last Update Date:2018-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60599879225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist