Provider Demographics
NPI:1346544467
Name:LASZINSKI, GARTH F (MED, ATC)
Entity Type:Individual
Prefix:MR
First Name:GARTH
Middle Name:F
Last Name:LASZINSKI
Suffix:
Gender:M
Credentials:MED, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 359
Mailing Address - Street 2:
Mailing Address - City:SHEBOYGAN
Mailing Address - State:WI
Mailing Address - Zip Code:53082-0359
Mailing Address - Country:US
Mailing Address - Phone:920-565-1252
Mailing Address - Fax:920-565-1399
Practice Address - Street 1:W3718 SOUTH DR
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:WI
Practice Address - Zip Code:53073-4878
Practice Address - Country:US
Practice Address - Phone:920-565-1252
Practice Address - Fax:920-565-1399
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-04
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI703-0392255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer