Healthcare Provider Details

I. General information

NPI: 1700517232
Provider Name (Legal Business Name): RAPHAELLE LAZARRE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2022
Last Update Date: 08/19/2024
Certification Date: 08/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 INDEPENDENCE AVE SE
WASHINGTON DC
20003-1733
US

IV. Provider business mailing address

1901 INDEPENDENCE AVE SE
WASHINGTON DC
20003-1733
US

V. Phone/Fax

Practice location:
  • Phone: 202-350-8680
  • Fax:
Mailing address:
  • Phone: 202-350-8680
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT210002457
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: