Healthcare Provider Details

I. General information

NPI: 1073099321
Provider Name (Legal Business Name): EDMER LAZARO PT, DPT, MSHCA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2018
Last Update Date: 07/14/2023
Certification Date: 07/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

164 COLCHESTER DR
IOWA CITY IA
52245-9346
US

IV. Provider business mailing address

164 COLCHESTER DR
IOWA CITY IA
52245-9346
US

V. Phone/Fax

Practice location:
  • Phone: 415-724-5278
  • Fax:
Mailing address:
  • Phone: 415-724-5278
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: