Provider Demographics
NPI:1235886557
Name:LAKAS PT, INC.
Entity Type:Organization
Organization Name:LAKAS PT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KIMBERLY ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:MANLANGIT
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:209-730-3053
Mailing Address - Street 1:965 BRIDGE ST APT 305
Mailing Address - Street 2:
Mailing Address - City:WEST SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95691-3351
Mailing Address - Country:US
Mailing Address - Phone:209-730-3053
Mailing Address - Fax:
Practice Address - Street 1:1914 L ST
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95811-4141
Practice Address - Country:US
Practice Address - Phone:916-841-5416
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-07
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy