Provider Demographics
NPI:1851628747
Name:LAZO, ALEXANDRA S (LMT)
Entity Type:Individual
Prefix:MS
First Name:ALEXANDRA
Middle Name:S
Last Name:LAZO
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1029 N KELLOGG ST
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336
Mailing Address - Country:US
Mailing Address - Phone:509-735-9355
Mailing Address - Fax:509-783-0259
Practice Address - Street 1:1029 N KELLOGG ST
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336
Practice Address - Country:US
Practice Address - Phone:509-735-9355
Practice Address - Fax:509-783-0259
Is Sole Proprietor?:No
Enumeration Date:2009-11-12
Last Update Date:2019-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00024324225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist