Provider Demographics
NPI:1538129119
Name:LASKA, MARYANN (PT ATC)
Entity Type:Individual
Prefix:MS
First Name:MARYANN
Middle Name:
Last Name:LASKA
Suffix:
Gender:F
Credentials:PT ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 ROSANNE LN
Mailing Address - Street 2:PO BOX 312
Mailing Address - City:PLAINVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06062-2654
Mailing Address - Country:US
Mailing Address - Phone:860-747-6874
Mailing Address - Fax:
Practice Address - Street 1:110 WOODBURY RD
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:CT
Practice Address - Zip Code:06795-2130
Practice Address - Country:US
Practice Address - Phone:860-945-7713
Practice Address - Fax:860-945-7942
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001283225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist