Healthcare Provider Details

I. General information

NPI: 1124953914
Provider Name (Legal Business Name): ALEJANDRA C LAZO PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

722 S DARGAN ST
FLORENCE SC
29506-2562
US

IV. Provider business mailing address

145 CHATFIELD CIR
GOOSE CREEK SC
29445-7092
US

V. Phone/Fax

Practice location:
  • Phone: 843-669-4403
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number13344
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number13344
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: