MEDICARE: SAMANTHA LAZARSKI

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	2174974	TX

General Provider Information

NPI Number	:	1114609112
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHA LAZARSKI

Provider Business Mailing Address
First Line	:	2250 E PALM VALLEY BLVD STE 205
Second Line	:
City	:	ROUND ROCK
State	:	TX
Zip	:	78665-4534
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2250 E PALM VALLEY BLVD STE 205
Second Line	:
City	:	ROUND ROCK
State	:	TX
Zip	:	78665-4534
Country	:	US
Telephone Number	:	512-975-7199
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/01/2023
Last Update Date	:	08/01/2023

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Directions to “ SAMANTHA LAZARSKI ” Practice Location

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