Provider Demographics
NPI:1144419441
Name:LAZO, TATIANA M (MS,PT)
Entity Type:Individual
Prefix:MISS
First Name:TATIANA
Middle Name:M
Last Name:LAZO
Suffix:
Gender:F
Credentials:MS,PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 CUMMING ST APT 3L
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10034-4817
Mailing Address - Country:US
Mailing Address - Phone:917-645-6480
Mailing Address - Fax:
Practice Address - Street 1:25 CUMMING ST APT 3L
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10034-4817
Practice Address - Country:US
Practice Address - Phone:917-645-6480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-23
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025801-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist