Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology | PT26448 | CA |
NPI | 1447711023 |
---|---|
Provider Name | Mr. Covey J Lazouras |
First Address | Downey, CA 90242-3456 |
Second Address | Downey, CA 90242-3456 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/03/2019 |
Last Update Date | 27/03/2019 |