Healthcare Provider Details

I. General information

NPI: 1881008167
Provider Name (Legal Business Name): ASHLEY LAZAS ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2014
Last Update Date: 06/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 IRVING ST NW
WASHINGTON DC
20010-2921
US

IV. Provider business mailing address

7960 PARKLAND PL
FREDERICK MD
21701-9309
US

V. Phone/Fax

Practice location:
  • Phone: 202-877-4674
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number2000007589
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: