MEDICARE: SONIA LASKIN LAT, ATC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2083S0010X	Sports Medicine (Preventive Medicine) Physician	AT9566	TX

General Provider Information

NPI Number	:	1275311193
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SONIA LASKIN LAT, ATC

Provider Business Mailing Address
First Line	:	2737 N FITZHUGH AVE APT 2324
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75204-3299
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2737 N FITZHUGH AVE APT 2324
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75204-3299
Country	:	US
Telephone Number	:	916-995-2532
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2023
Last Update Date	:	09/20/2023

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