Individual
TODD LAZENBY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MA, ATC
Contact information
Practice address
953 DANBY RD, G68 HILL CENTER, ITHACA, NY 14850-7000
(607) 274-1717
Mailing address
953 DANBY RD, G68 HILL CENTER, ITHACA, NY 14850-7000
(607) 274-1717
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
001573-1
NY
Other
Enumeration date
12/12/2013
Last updated
12/12/2013
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