Provider Demographics
NPI:1992272801
Name:CORTEZ VELAZCO, LORENZO ANTONIO (ATC)
Entity type:Individual
Prefix:MR
First Name:LORENZO
Middle Name:ANTONIO
Last Name:CORTEZ VELAZCO
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1416 BEVERLY DR
Mailing Address - Street 2:
Mailing Address - City:ROUND LAKE BEACH
Mailing Address - State:IL
Mailing Address - Zip Code:60073-1509
Mailing Address - Country:US
Mailing Address - Phone:224-814-9456
Mailing Address - Fax:
Practice Address - Street 1:625 ENTERPRISE DR
Practice Address - Street 2:
Practice Address - City:OAK BROOK
Practice Address - State:IL
Practice Address - Zip Code:60523-8813
Practice Address - Country:US
Practice Address - Phone:224-814-9456
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-29
Last Update Date:2018-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0960046102255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer