Provider Demographics
NPI:1881844702
Name:MASTRANGELO, LORENZO (RPT)
Entity Type:Individual
Prefix:MR
First Name:LORENZO
Middle Name:
Last Name:MASTRANGELO
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:266 MAIN AVE
Mailing Address - Street 2:APT. 6
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06851-6126
Mailing Address - Country:US
Mailing Address - Phone:203-840-1582
Mailing Address - Fax:
Practice Address - Street 1:23 PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06850-3705
Practice Address - Country:US
Practice Address - Phone:203-857-4605
Practice Address - Fax:203-857-4605
Is Sole Proprietor?:No
Enumeration Date:2008-09-27
Last Update Date:2008-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT004855225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist