Provider Demographics
NPI:1063373934
Name:LAURITZEN, WAYNE STEPHEN (LAT, ATC)
Entity type:Individual
Prefix:
First Name:WAYNE
Middle Name:STEPHEN
Last Name:LAURITZEN
Suffix:
Gender:M
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 COPPER LAKE LN
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78628-7179
Mailing Address - Country:US
Mailing Address - Phone:512-844-9330
Mailing Address - Fax:
Practice Address - Street 1:115 COPPER LAKE LN
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78628-7179
Practice Address - Country:US
Practice Address - Phone:512-844-9330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-11-20
Last Update Date:2025-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer