Provider Demographics
NPI:1851460083
Name:LAZOR & BENLOCK PHYSICAL THERAPY AND SPORTS MEDICINE, INC.
Entity Type:Organization
Organization Name:LAZOR & BENLOCK PHYSICAL THERAPY AND SPORTS MEDICINE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGE
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:BONIDIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-835-2626
Mailing Address - Street 1:110 FORT COUCH RD
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15241-1030
Mailing Address - Country:US
Mailing Address - Phone:412-835-2626
Mailing Address - Fax:412-835-2526
Practice Address - Street 1:110 FORT COUCH RD
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15241-1030
Practice Address - Country:US
Practice Address - Phone:412-835-2626
Practice Address - Fax:412-835-2526
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA239906OtherHEALTH AMERICA
PA1620886OtherBCBS
PA239906OtherHEALTH AMERICA