Healthcare Provider Details

I. General information

NPI: 1194256495
Provider Name (Legal Business Name): JOSE LEZCANO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2017
Last Update Date: 08/29/2026
Certification Date: 08/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 STRATFORD AVE APT 319
STRATFORD CT
06615-6379
US

IV. Provider business mailing address

1111 STRATFORD AVE APT 319
STRATFORD CT
06615-6379
US

V. Phone/Fax

Practice location:
  • Phone: 786-683-4007
  • Fax:
Mailing address:
  • Phone: 786-683-4007
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number27272
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2122
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: