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General NPI Number Information
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NPI Number | 1679043228
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Entity Type | Organization
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Legal Business Name | LAZARO PHYSICAL THERAPY
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Dates
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Enumeration Date | 11/27/2018
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Last Update Date | 06/27/2019
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Provider Practice Location Address
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Address Line | 20861 WILBEAM AVE STE 9
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City | CASTRO VALLEY
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State | CA
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Zip | 94546-5832
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Country | US
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Telephone | 415-724-5278
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Fax |
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Provider Business Mailing Address
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Address Line | 2612 ERSKINE LN
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City | HAYWARD
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State | CA
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Zip | 94545-3028
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Country | US
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Telephone | 415-724-5278
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Fax |
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | DR. EDMER LAZARO
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Credential | PT, DPT, MS-HCA, OCS
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Telephone | 415-724-5278
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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