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General NPI Number Information
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NPI Number | 1346544467
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Entity Type | Individual
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Provider Name | GARTH F LASZINSKI M.ED., ATC
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Gender | Male
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Dates
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Enumeration Date | 01/04/2011
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Last Update Date | 01/04/2011
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Provider Practice Location Address
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Address Line | W3718 SOUTH DR
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City | PLYMOUTH
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State | WI
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Zip | 53073-4878
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Country | US
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Telephone | 920-565-1252
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Fax | 920-565-1399
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Provider Business Mailing Address
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Address Line | PO BOX 359
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City | SHEBOYGAN
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State | WI
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Zip | 53082-0359
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Country | US
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Telephone | 920-565-1252
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Fax | 920-565-1399
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 703-039
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License Number State | WI
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