=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699618918
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LAZZO PT
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/11/2026
-----------------------------------------------------
Last Update Date | 04/11/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3500 N ROCK RD STE B
-----------------------------------------------------
City | WICHITA
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67226-1341
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-230-0185
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9442 E CROSS CREEK CT
-----------------------------------------------------
City | WICHITA
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67206-4064
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-230-0185
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | COURTNEY LAZZO
-----------------------------------------------------
Credential | DPT
-----------------------------------------------------
Telephone | 402-230-0185
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------