Provider Demographics
NPI:1053005793
Name:LORENZO, JOSE CARLOS (PTA)
Entity type:Individual
Prefix:MR
First Name:JOSE
Middle Name:CARLOS
Last Name:LORENZO
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12931 SW 17TH CT
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-2535
Mailing Address - Country:US
Mailing Address - Phone:754-201-5297
Mailing Address - Fax:
Practice Address - Street 1:12931 SW 17TH CT
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33027-2535
Practice Address - Country:US
Practice Address - Phone:754-201-5297
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-06
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL31682225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant