Provider Demographics
NPI:1275705154
Name:LAKATOSH, KARA A (PT)
Entity Type:Individual
Prefix:
First Name:KARA
Middle Name:A
Last Name:LAKATOSH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7875
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915
Mailing Address - Country:US
Mailing Address - Phone:888-967-2843
Mailing Address - Fax:617-402-1099
Practice Address - Street 1:11560 CHAPMAN HWY
Practice Address - Street 2:STE 1
Practice Address - City:SEYMOUR
Practice Address - State:TN
Practice Address - Zip Code:37865-5044
Practice Address - Country:US
Practice Address - Phone:865-577-1914
Practice Address - Fax:865-577-1714
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-31
Last Update Date:2016-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPT 5802208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3650128Medicare PIN