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NPI Code Detail

MEDICARE: MS. DIANE MARIE LASECKI P.T.A.

MEDICARE: MS. DIANE MARIE LASECKI P.T.A.
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
1174400000XSpecialistPTA01684OH

General Provider Information

NPI Number : 1326174277
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. DIANE MARIE LASECKI P.T.A.
Provider Business Mailing Address
First Line : 3645 W 104TH ST
Second Line :
City : CLEVELAND
State : OH
Zip : 44111-3818
Country : US
Telephone Number : 216-341-3885
Fax Number : 216-941-3885
Provider Business Practice Location Address
First Line : 1275 LAKESIDE AVE E
Second Line :
City : CLEVELAND
State : OH
Zip : 44114-1132
Country : US
Telephone Number : 216-736-2612
Fax Number : 216-241-8230
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/26/2007
Last Update Date : 07/08/2007

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