Provider Demographics
NPI:1659486603
Name:LAKESIDE MANUAL PHYSICAL THERAPY INC.
Entity Type:Organization
Organization Name:LAKESIDE MANUAL PHYSICAL THERAPY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:CHISTINE
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:540-854-0367
Mailing Address - Street 1:9445 ZACHARY TAYLOR HWY
Mailing Address - Street 2:
Mailing Address - City:UNIONVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22567-2126
Mailing Address - Country:US
Mailing Address - Phone:540-854-0367
Mailing Address - Fax:540-854-0369
Practice Address - Street 1:9445 ZACHARY TAYLOR HWY
Practice Address - Street 2:
Practice Address - City:UNIONVILLE
Practice Address - State:VA
Practice Address - Zip Code:22567-2126
Practice Address - Country:US
Practice Address - Phone:540-854-0367
Practice Address - Fax:540-854-0369
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA195167OtherBLUE CROSS BLUE SHIELD
VADC1580OtherMEDICARE RAILROAD
VAC08388Medicare PIN
VAP63307Medicare UPIN