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General NPI Number Information
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NPI Number | 1376819672
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Entity Type | Organization
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Legal Business Name | THERA PEAK PT PC
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Dates
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Enumeration Date | 03/30/2012
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Last Update Date | 03/30/2012
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Provider Practice Location Address
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Address Line | 70 AVENUE O
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City | BROOKLYN
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State | NY
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Zip | 11204-6448
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Country | US
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Telephone | 347-576-1604
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Fax |
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Provider Business Mailing Address
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Address Line | 70 AVENUE O
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City | BROOKLYN
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State | NY
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Zip | 11204-6448
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Country | US
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Telephone | 347-576-1604
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MICHAEL B LAZO
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Credential | PT
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Telephone | 347-576-1604
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 020711
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License Number State |
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