Healthcare Provider Details

I. General information

NPI: 1629137989
Provider Name (Legal Business Name): LISA LYNN LAZAR ATC, LAT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

718 HIGHRIDGE AVE
GREENCASTLE IN
46135-1402
US

IV. Provider business mailing address

718 HIGHRIDGE AVE
GREENCASTLE IN
46135-1402
US

V. Phone/Fax

Practice location:
  • Phone: 765-653-0061
  • Fax:
Mailing address:
  • Phone: 765-653-0061
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: