Provider Demographics
NPI:1740550540
Name:LAZORKO, JENNIFER LYNN (DOC OF PHYSICAL THER)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LYNN
Last Name:LAZORKO
Suffix:
Gender:F
Credentials:DOC OF PHYSICAL THER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:930 W RALPH HALL PKWY STE 120
Mailing Address - Street 2:
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75032-6664
Mailing Address - Country:US
Mailing Address - Phone:972-771-0999
Mailing Address - Fax:972-771-2281
Practice Address - Street 1:930 W RALPH HALL PKWY STE 120
Practice Address - Street 2:
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75032-6664
Practice Address - Country:US
Practice Address - Phone:972-771-0999
Practice Address - Fax:972-771-2281
Is Sole Proprietor?:No
Enumeration Date:2012-01-10
Last Update Date:2014-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1205946225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1205946OtherLICENSE NUMBER