Provider Demographics
NPI:1326101387
Name:LAZICKI, STEVEN R (PT)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:R
Last Name:LAZICKI
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:ROUTE 209
Mailing Address - Street 2:PO BOX 1020
Mailing Address - City:KRESGEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18333
Mailing Address - Country:US
Mailing Address - Phone:610-681-3637
Mailing Address - Fax:610-681-6344
Practice Address - Street 1:WEST END PYSICAL THERAPY
Practice Address - Street 2:ROUTE 209
Practice Address - City:KRESGEVILLE
Practice Address - State:PA
Practice Address - Zip Code:18333
Practice Address - Country:US
Practice Address - Phone:610-681-3637
Practice Address - Fax:610-681-6344
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT005944L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
002308Medicare ID - Type Unspecified