Provider Demographics
NPI:1801199336
Name:LONE LAKE PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:LONE LAKE PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:EM
Authorized Official - Last Name:ARNDT
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:360-321-2652
Mailing Address - Street 1:PO BOX 260
Mailing Address - Street 2:
Mailing Address - City:LANGLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98260-0260
Mailing Address - Country:US
Mailing Address - Phone:360-321-4434
Mailing Address - Fax:
Practice Address - Street 1:2848 ANDREASON RD
Practice Address - Street 2:
Practice Address - City:LANGLEY
Practice Address - State:WA
Practice Address - Zip Code:98260-8507
Practice Address - Country:US
Practice Address - Phone:360-321-4434
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-05
Last Update Date:2010-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT 10185225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty