Healthcare Provider Details

I. General information

NPI: 1427173491
Provider Name (Legal Business Name): TARA LEZEAU PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1027 COUNTRY CLUB RD
MONONGAHELA PA
15063-1553
US

IV. Provider business mailing address

1027 COUNTRY CLUB RD
MONONGAHELA PA
15063-1553
US

V. Phone/Fax

Practice location:
  • Phone: 724-258-6211
  • Fax: 724-258-6225
Mailing address:
  • Phone: 724-258-6211
  • Fax: 724-258-6225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT014121L
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: