1194833665 NPI number — MS. LORI JANE VANCZA LAT,ATC

Table of content: MS. JAMIE A REZENDES M.ED. (NPI 1871693929)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194833665 NPI number — MS. LORI JANE VANCZA LAT,ATC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VANCZA
Provider First Name:
LORI
Provider Middle Name:
JANE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LAT,ATC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1194833665
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1802 COLLEGE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TERRE HAUTE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47803-4033
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
812-235-6299
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
401 N 4TH ST
Provider Second Line Business Practice Location Address:
HHP BLDG RM B-17
Provider Business Practice Location Address City Name:
TERRE HAUTE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47809-1934
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-237-4062
Provider Business Practice Location Address Fax Number:
812-237-9612
Provider Enumeration Date:
08/26/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2255A2300X , with the licence number:  36000226A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)