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General NPI Number Information
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NPI Number | 1619272812
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Entity Type | Individual
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Provider Name | KELLY LAZAUSKAS PTA
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Gender | Female
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Dates
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Enumeration Date | 01/19/2011
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Last Update Date | 01/19/2011
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Provider Practice Location Address
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Address Line | 7019 NW CACHE RD
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City | LAWTON
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State | OK
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Zip | 73505
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Country | US
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Telephone | 580-536-1279
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Fax |
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Provider Business Mailing Address
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Address Line | 15100 HIGHLAND LN
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City | MINNETONKA
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State | MN
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Zip | 55345-3619
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Country | US
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Telephone | 952-930-3091
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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 | 1977
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | A1346
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License Number State | MN
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Taxonomy #3
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 001503
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License Number State | IA
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Taxonomy #4
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 941
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License Number State | NE
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Taxonomy #5
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 1718-019
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License Number State | WI
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