Individual
MRS. SHANNON LAZCANO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
7517 W COLDSPRING RD, MILWAUKEE, WI 53220-2814
(414) 327-6603
Mailing address
641 S 67TH ST, MILWAUKEE, WI 53214-1747
(414) 322-5564
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
954-19
WI
Other
Enumeration date
01/31/2012
Last updated
01/31/2012
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