Provider Demographics
NPI:1245235183
Name:HEALTHWORKS OF LAKE CITY, INC.
Entity Type:Organization
Organization Name:HEALTHWORKS OF LAKE CITY, INC.
Other - Org Name:HEALTHWORKS REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:BEARDSLEY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:386-752-1652
Mailing Address - Street 1:1206 SW MAIN BLVD
Mailing Address - Street 2:STE 101
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32025-6684
Mailing Address - Country:US
Mailing Address - Phone:386-752-1652
Mailing Address - Fax:386-752-0939
Practice Address - Street 1:1206 SW MAIN BLVD
Practice Address - Street 2:STE 101
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32025-6684
Practice Address - Country:US
Practice Address - Phone:386-752-1652
Practice Address - Fax:386-752-0939
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-16
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT17329174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY7572OtherBCBS PROVIDER NUMBER
FLY7572OtherBCBS PROVIDER NUMBER