Individual
SUSAN Z LASTRA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PT, DPT
Contact information
Practice address
30 PROSPECT AVE, HACKENSACK, NJ 07601-1915
(201) 638-6073
Mailing address
PO BOX 322, WOOD RIDGE, NJ 07075-0322
(201) 638-6073
Taxonomy
Speciality
Code
Description
License number
State
2251P0200X
Pediatric Physical Therapist
Primary
40QA00435300
NJ
Other
Enumeration date
05/14/2024
Last updated
05/15/2024
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