Healthcare Provider Details

I. General information

NPI: 1225414899
Provider Name (Legal Business Name): DANIEL CARLOS LAZO DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2015
Last Update Date: 04/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17796 SW 2ND ST
PEMBROKE PINES FL
33029-3923
US

IV. Provider business mailing address

807 NW 133RD CT
MIAMI FL
33182-2201
US

V. Phone/Fax

Practice location:
  • Phone: 954-438-7800
  • Fax:
Mailing address:
  • Phone: 305-310-7357
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number30629
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: