Provider Demographics
NPI:1982609541
Name:FORTUNO, LORENZ FORTUNE (PT, DPT)
Entity Type:Individual
Prefix:MR
First Name:LORENZ
Middle Name:FORTUNE
Last Name:FORTUNO
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7724 HAYFIELD RD
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22315-4052
Mailing Address - Country:US
Mailing Address - Phone:571-594-4615
Mailing Address - Fax:703-971-2069
Practice Address - Street 1:7724 HAYFIELD RD
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22315-4052
Practice Address - Country:US
Practice Address - Phone:571-594-4615
Practice Address - Fax:703-971-2069
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-20
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD19525225100000X
VA2305202501225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
46950048OtherCAREFIRST DC