Basic Information
| Provider Information | |||||||||
| NPI: | 1538417233 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LAKE HEALTH & REHAB, LLC | ||||||||
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| OtherOrganizationName: | PROFESSIONAL THERAPY ASSOCIATES | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 5718 | ||||||||
| Address2: | SUITE B | ||||||||
| City: | KALISPELL | ||||||||
| State: | MT | ||||||||
| PostalCode: | 599035718 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8554567146 | ||||||||
| FaxNumber: | 4063092579 | ||||||||
| Practice Location | |||||||||
| Address1: | 306 STONER LOOP STE 3 | ||||||||
| Address2: | |||||||||
| City: | LAKESIDE | ||||||||
| State: | MT | ||||||||
| PostalCode: | 599228601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4068440744 | ||||||||
| FaxNumber: | 4068440759 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/28/2012 | ||||||||
| LastUpdateDate: | 03/18/2017 | ||||||||
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| AuthorizedOfficialLastName: | INC. | ||||||||
| AuthorizedOfficialFirstName: | HEALTH AND REHAB | ||||||||
| AuthorizedOfficialMiddleName: | SOLUTIONS | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO, PT | ||||||||
| AuthorizedOfficialTelephone: | 4067561128 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | HEALTH & REHAB SOLUTIONS, INC. | ||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | PT | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 1614 | MT | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.