Healthcare Provider Details

I. General information

NPI: 1821546631
Provider Name (Legal Business Name): CHRISTINE MARIE LANZA BM, MM, MFA, PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2016
Last Update Date: 09/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8540 SCARBOROUGH DR SUITE 200
COLORADO SPRINGS CO
80920-7502
US

IV. Provider business mailing address

8540 SCARBOROUGH DR SUITE 200
COLORADO SPRINGS CO
80920-7502
US

V. Phone/Fax

Practice location:
  • Phone: 719-630-7500
  • Fax: 719-630-8099
Mailing address:
  • Phone: 719-630-7500
  • Fax: 719-630-8099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberPTA.0013920
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: