Healthcare Provider Details

I. General information

NPI: 1184901043
Provider Name (Legal Business Name): TADEUSZ LASKA PT.DPT.OCS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2011
Last Update Date: 11/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 HOMESTEAD AVE
WHEELING WV
26003-6638
US

IV. Provider business mailing address

20 HOMESTEAD AVE.
WHEELING WV
26003
US

V. Phone/Fax

Practice location:
  • Phone: 304-234-0558
  • Fax:
Mailing address:
  • Phone: 304-234-0558
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number000942
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: