Individual
CLINTON ROBERT LACKAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PT, DPT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
16034-24
WI
Other
Enumeration date
05/09/2023
Last updated
05/09/2023
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