Provider Demographics
NPI:1396010450
Name:LAKE AREA PHYSICAL THERAPY INC
Entity Type:Organization
Organization Name:LAKE AREA PHYSICAL THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:HODGES
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:352-475-3113
Mailing Address - Street 1:PO BOX 1099
Mailing Address - Street 2:
Mailing Address - City:MELROSE
Mailing Address - State:FL
Mailing Address - Zip Code:32666-1099
Mailing Address - Country:US
Mailing Address - Phone:352-475-3113
Mailing Address - Fax:352-475-5796
Practice Address - Street 1:1554 S WATER ST
Practice Address - Street 2:
Practice Address - City:STARKE
Practice Address - State:FL
Practice Address - Zip Code:32091-4511
Practice Address - Country:US
Practice Address - Phone:904-964-2208
Practice Address - Fax:904-966-2203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-21
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty