Provider Demographics
NPI:1205289014
Name:LASKY, LAWRENCE (MED, ATC/LAT)
Entity type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:
Last Name:LASKY
Suffix:
Gender:M
Credentials:MED, ATC/LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15043 SUMMIT PLACE CIR
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34119-4105
Mailing Address - Country:US
Mailing Address - Phone:850-501-8889
Mailing Address - Fax:
Practice Address - Street 1:15043 SUMMIT PLACE CIR
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34119-4105
Practice Address - Country:US
Practice Address - Phone:850-501-8889
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-16
Last Update Date:2016-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL5172255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer