Provider Demographics
NPI:1588357289
Name:LAZO, OLIVIA ANTOINETTE ORCUTT (PT, DPT)
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:ANTOINETTE ORCUTT
Last Name:LAZO
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 392573
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15251-9573
Mailing Address - Country:US
Mailing Address - Phone:724-343-4060
Mailing Address - Fax:
Practice Address - Street 1:4451 MAHONING AVE NW STE A
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44483-1977
Practice Address - Country:US
Practice Address - Phone:330-372-0207
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-30
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCCP021910T225100000X
OHCP031839T225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCCP021910TOtherPT LICENSE