Provider Demographics
NPI:1972976405
Name:THREE LAKES PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:THREE LAKES PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HARTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:512-328-8912
Mailing Address - Street 1:5000 BEE CAVES RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WEST LAKE HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:78746-5266
Mailing Address - Country:US
Mailing Address - Phone:512-328-8912
Mailing Address - Fax:
Practice Address - Street 1:5000 BEE CAVES RD
Practice Address - Street 2:SUITE 200
Practice Address - City:WEST LAKE HILLS
Practice Address - State:TX
Practice Address - Zip Code:78746-5266
Practice Address - Country:US
Practice Address - Phone:512-328-8912
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-05
Last Update Date:2015-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty