Provider Demographics
NPI:1790490324
Name:LASARRUS CLINIC AND RESEARCH CENTER
Entity Type:Organization
Organization Name:LASARRUS CLINIC AND RESEARCH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NELSON
Authorized Official - Middle Name:
Authorized Official - Last Name:EMOKPAE
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:410-591-4306
Mailing Address - Street 1:1100 WICOMICO ST STE 330
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21230-2046
Mailing Address - Country:US
Mailing Address - Phone:301-388-5453
Mailing Address - Fax:
Practice Address - Street 1:1100 WICOMICO ST STE 330
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21230-2046
Practice Address - Country:US
Practice Address - Phone:301-388-5453
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-18
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty