Provider Demographics
NPI:1548762313
Name:LORENTZ, DANIEL RAYMOND (DPT, CSCS)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:RAYMOND
Last Name:LORENTZ
Suffix:
Gender:M
Credentials:DPT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 KINSELLA AVE
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11762-3337
Mailing Address - Country:US
Mailing Address - Phone:516-884-1182
Mailing Address - Fax:
Practice Address - Street 1:8 SAXON AVE
Practice Address - Street 2:
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-7036
Practice Address - Country:US
Practice Address - Phone:631-206-2989
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-07
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY042415225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist