Provider Demographics
NPI:1639783699
Name:LAZU, ANGEL LOUIS (ATC)
Entity Type:Individual
Prefix:
First Name:ANGEL
Middle Name:LOUIS
Last Name:LAZU
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 VAIRO BLVD APT 1112
Mailing Address - Street 2:
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16803
Mailing Address - Country:US
Mailing Address - Phone:267-394-0822
Mailing Address - Fax:
Practice Address - Street 1:276 RECREATION BLDG # 147D
Practice Address - Street 2:
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16802-5701
Practice Address - Country:US
Practice Address - Phone:814-867-0478
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-06
Last Update Date:2020-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART0073812255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer