Provider Demographics
NPI:1932611795
Name:LAURENITIS, ANTHONY (DPT)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
Last Name:LAURENITIS
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 452
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:CT
Mailing Address - Zip Code:06037-0452
Mailing Address - Country:US
Mailing Address - Phone:860-829-5511
Mailing Address - Fax:860-829-5577
Practice Address - Street 1:190 FENN RD
Practice Address - Street 2:
Practice Address - City:NEWINGTON
Practice Address - State:CT
Practice Address - Zip Code:06111-2244
Practice Address - Country:US
Practice Address - Phone:860-665-1177
Practice Address - Fax:860-665-9922
Is Sole Proprietor?:No
Enumeration Date:2017-11-01
Last Update Date:2020-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT011492208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation