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General NPI Number Information
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NPI Number | 1336415215
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Entity Type | Individual
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Provider Name | COURTNEY LAZZO DPT
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Gender | Female
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Dates
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Enumeration Date | 03/26/2012
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Last Update Date | 08/22/2016
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Provider Practice Location Address
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Address Line | 2081 N WEBB RD SUITE B
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City | WICHITA
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State | KS
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Zip | 67206-3402
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Country | US
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Telephone | 316-260-8239
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Fax | 316-462-5767
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Provider Business Mailing Address
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Address Line | 1094 N BEDFORD CT
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City | WICHITA
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State | KS
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Zip | 67206-4353
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Country | US
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Telephone | 402-230-0185
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 14-02250
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License Number State | KS
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 1105493
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License Number State | KS
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