Provider Demographics
NPI:1396815759
Name:LAZZARINI, JANA M'LYN (PT)
Entity Type:Individual
Prefix:MRS
First Name:JANA
Middle Name:M'LYN
Last Name:LAZZARINI
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:JANA
Other - Middle Name:M'LYN
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:PO BOX 10340
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76547-0340
Mailing Address - Country:US
Mailing Address - Phone:254-699-3933
Mailing Address - Fax:254-526-8604
Practice Address - Street 1:3816 S CLEAR CREEK RD
Practice Address - Street 2:SUITE B
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76549-4400
Practice Address - Country:US
Practice Address - Phone:254-699-3933
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1170447225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist