Healthcare Provider Details

I. General information

NPI: 1619764164
Provider Name (Legal Business Name): BRITNEY LAATSCH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2025
Last Update Date: 04/21/2025
Certification Date: 04/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

324 BIRCHWOOD LN
THERESA WI
53091-9636
US

IV. Provider business mailing address

324 BIRCHWOOD LN
THERESA WI
53091-9636
US

V. Phone/Fax

Practice location:
  • Phone: 920-204-1534
  • Fax:
Mailing address:
  • Phone: 920-204-1534
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: