Healthcare Provider Details

I. General information

NPI: 1396714580
Provider Name (Legal Business Name): MICHELLE M LAZARSKI PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2006
Last Update Date: 02/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1003 EASTON RD 105 CHATEAU
WILLOW GROVE PA
19090-2027
US

IV. Provider business mailing address

1003 EASTON RD 105 CHATEAU
WILLOW GROVE PA
19090-2027
US

V. Phone/Fax

Practice location:
  • Phone: 215-659-7759
  • Fax: 215-659-6658
Mailing address:
  • Phone: 215-659-7759
  • Fax: 215-659-6658

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT001523E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: