Provider Demographics
NPI:1992486534
Name:CO, LORENZO JOSE (PT)
Entity type:Individual
Prefix:
First Name:LORENZO JOSE
Middle Name:
Last Name:CO
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2361 COOLEY PL
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91104-3415
Mailing Address - Country:US
Mailing Address - Phone:626-497-5644
Mailing Address - Fax:
Practice Address - Street 1:16553 RINALDI ST
Practice Address - Street 2:
Practice Address - City:GRANADA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91344-3798
Practice Address - Country:US
Practice Address - Phone:818-360-1003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-27
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA295035225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist