Healthcare Provider Details

I. General information

NPI: 1194551770
Provider Name (Legal Business Name): ERIC ARTHUR LAZAR PT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2024
Last Update Date: 09/11/2024
Certification Date: 09/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1460 DREW AVE STE 200
DAVIS CA
95618-4856
US

IV. Provider business mailing address

2033 MANET PL
DAVIS CA
95618-0536
US

V. Phone/Fax

Practice location:
  • Phone: 530-753-9011
  • Fax:
Mailing address:
  • Phone: 530-758-8924
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT306809
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: