Healthcare Provider Details

I. General information

NPI: 1689895609
Provider Name (Legal Business Name): CHRISTINA RAE LASKY MPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 W BASS ST
KISSIMMEE FL
34741-5011
US

IV. Provider business mailing address

508 NEPTUNE BAY CIR APT. 5086
SAINT CLOUD FL
34769-7022
US

V. Phone/Fax

Practice location:
  • Phone: 407-870-5959
  • Fax:
Mailing address:
  • Phone: 321-766-7581
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT23111
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: