MEDICARE: ALBERT F LAZO PT

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	225100000X	Physical Therapist	10363	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1245347178
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALBERT F LAZO PT

Provider Business Mailing Address
First Line	:	9052 W QUAIL TRACK DR
Second Line	:
City	:	PEORIA
State	:	AZ
Zip	:	85383-3750
Country	:	US
Telephone Number	:	480-221-7423
Fax Number	:

Provider Business Practice Location Address
First Line	:	17233 N HOLMES BLVD
Second Line	:	SUITE 1650
City	:	PHOENIX
State	:	AZ
Zip	:	85053-2018
Country	:	US
Telephone Number	:	602-547-1836
Fax Number	:	602-547-0809

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

Provider Enumeration Date	:	08/24/2006
Last Update Date	:	01/22/2014

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Directions to “ ALBERT F LAZO PT” Practice Location

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