Provider Demographics
NPI:1245347178
Name:LAZO, ALBERT F (PT)
Entity type:Individual
Prefix:
First Name:ALBERT
Middle Name:F
Last Name:LAZO
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9052 W QUAIL TRACK DR
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85383-3750
Mailing Address - Country:US
Mailing Address - Phone:480-221-7423
Mailing Address - Fax:
Practice Address - Street 1:17233 N HOLMES BLVD
Practice Address - Street 2:SUITE 1650
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85053-2018
Practice Address - Country:US
Practice Address - Phone:602-547-1836
Practice Address - Fax:602-547-0809
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2014-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ10363225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ331744Medicaid
AZ29146Medicare ID - Type Unspecified