Provider Demographics
NPI:1376222653
Name:LAZARO PHYSICAL THERAPY, PLC
Entity Type:Organization
Organization Name:LAZARO PHYSICAL THERAPY, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDMER
Authorized Official - Middle Name:
Authorized Official - Last Name:LAZARO
Authorized Official - Suffix:
Authorized Official - Credentials:DPT, MSHCA
Authorized Official - Phone:415-724-5278
Mailing Address - Street 1:164 COLCHESTER DR
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52245-9346
Mailing Address - Country:US
Mailing Address - Phone:415-724-5278
Mailing Address - Fax:
Practice Address - Street 1:164 COLCHESTER DR
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52245-9346
Practice Address - Country:US
Practice Address - Phone:415-724-5278
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-14
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy