Healthcare Provider Details

I. General information

NPI: 1326101387
Provider Name (Legal Business Name): STEVEN R LAZICKI PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

WEST END PYSICAL THERAPY ROUTE 209
KRESGEVILLE PA
18333
US

IV. Provider business mailing address

ROUTE 209 PO BOX 1020
KRESGEVILLE PA
18333
US

V. Phone/Fax

Practice location:
  • Phone: 610-681-3637
  • Fax: 610-681-6344
Mailing address:
  • Phone: 610-681-3637
  • Fax: 610-681-6344

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT005944L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: