Healthcare Provider Details

I. General information

NPI: 1578440202
Provider Name (Legal Business Name): MARYANNE MARGARET LAZORE PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2025
Last Update Date: 08/15/2025
Certification Date: 08/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 MAIN ST
EAST AURORA NY
14052-1635
US

IV. Provider business mailing address

6 SLATE CREEK DR
BUFFALO NY
14227-3806
US

V. Phone/Fax

Practice location:
  • Phone: 716-714-9860
  • Fax:
Mailing address:
  • Phone: 315-247-3130
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number054977
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: