Active NPI
Angel Louis Lazu, ATC
- Athletic Trainer
- State College, PA
National Provider Identifier
1639783699
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- RT007381
- Practice address
- 276 Recreation BLDG # 147D
State College, PA 16802-5701 - Phone
- (814) 867-0478
- NPI assigned
- Sep 6, 2020
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | RT007381 | PA | Primary |
Addresses
Primary practice location
276 Recreation BLDG # 147D
State College, PA 16802-5701
Mailing address
501 Vairo Blvd Apt 1112
State College, PA 16803
Phone (267) 394-0822
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RT007381 | PA | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1599350400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1599350400000",
"number": "1639783699",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "501 VAIRO BLVD APT 1112",
"city": "STATE COLLEGE",
"state": "PA",
"postal_code": "16803",
"telephone_number": "267-394-0822"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "276 RECREATION BLDG # 147D",
"city": "STATE COLLEGE",
"state": "PA",
"postal_code": "168025701",
"telephone_number": "814-867-0478"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LAZU",
"first_name": "ANGEL",
"middle_name": "LOUIS",
"credential": "ATC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2020-09-06",
"last_updated": "2020-09-06",
"certification_date": "2020-08-31",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "PA",
"license": "RT007381",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in State College, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.