Provider Demographics
NPI:1457615171
Name:LAZARO, ANNACIELA (PT)
Entity Type:Individual
Prefix:
First Name:ANNACIELA
Middle Name:
Last Name:LAZARO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5451 82ND ST FL 1
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-4719
Mailing Address - Country:US
Mailing Address - Phone:347-475-6978
Mailing Address - Fax:
Practice Address - Street 1:5451 82ND ST FL 1
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-4719
Practice Address - Country:US
Practice Address - Phone:347-475-6978
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-27
Last Update Date:2012-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY30515225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist