Healthcare Provider Details

I. General information

NPI: 1265387641
Provider Name (Legal Business Name): EVAN LASKA DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/02/2026
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

641 DIVISION ST STE A
STEVENS POINT WI
54481-1841
US

IV. Provider business mailing address

2918 POST RD
STEVENS POINT WI
54481-6417
US

V. Phone/Fax

Practice location:
  • Phone: 715-345-2797
  • Fax: 715-345-7289
Mailing address:
  • Phone: 715-345-2126
  • Fax: 715-544-0095

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number17626-24
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: