Provider Demographics
NPI:1184221590
Name:LAZCANO, ALEJANDRO ANTONIO (PT, DPT)
Entity Type:Individual
Prefix:
First Name:ALEJANDRO
Middle Name:ANTONIO
Last Name:LAZCANO
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9324 SW 154TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33196-1140
Mailing Address - Country:US
Mailing Address - Phone:786-286-7989
Mailing Address - Fax:
Practice Address - Street 1:4900 S UNIVERSITY DR STE 106
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33328-3809
Practice Address - Country:US
Practice Address - Phone:954-705-5151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-08
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL36152225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist