Provider Demographics
NPI:1104679224
Name:LT TOTAL HEALTH
Entity type:Organization
Organization Name:LT TOTAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACUPUNCTURIST
Authorized Official - Prefix:
Authorized Official - First Name:LIA
Authorized Official - Middle Name:
Authorized Official - Last Name:LATERZA
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:141-438-8973
Mailing Address - Street 1:1117 ELLIS AVE
Mailing Address - Street 2:
Mailing Address - City:CALEDONIA
Mailing Address - State:WI
Mailing Address - Zip Code:53402-2780
Mailing Address - Country:US
Mailing Address - Phone:414-388-9736
Mailing Address - Fax:
Practice Address - Street 1:1117 ELLIS AVE
Practice Address - Street 2:
Practice Address - City:CALEDONIA
Practice Address - State:WI
Practice Address - Zip Code:53402-2780
Practice Address - Country:US
Practice Address - Phone:414-388-9736
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-09
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty