Provider Demographics
NPI:1679043228
Name:LAZARO PHYSICAL THERAPY
Entity Type:Organization
Organization Name:LAZARO PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDMER
Authorized Official - Middle Name:
Authorized Official - Last Name:LAZARO
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT, MS-HCA, OCS
Authorized Official - Phone:415-724-5278
Mailing Address - Street 1:2612 ERSKINE LN
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94545-3028
Mailing Address - Country:US
Mailing Address - Phone:415-724-5278
Mailing Address - Fax:
Practice Address - Street 1:20861 WILBEAM AVE STE 9
Practice Address - Street 2:
Practice Address - City:CASTRO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94546-5832
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:2018-11-27
Last Update Date:2019-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty