Provider Demographics
NPI:1013242734
Name:LAKE, AIMEE (DPT)
Entity Type:Individual
Prefix:
First Name:AIMEE
Middle Name:
Last Name:LAKE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8750 GREENWOOD AVE N STE S1
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-3684
Mailing Address - Country:US
Mailing Address - Phone:206-782-5789
Mailing Address - Fax:
Practice Address - Street 1:8750 GREENWOOD AVE N STE S1
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-3684
Practice Address - Country:US
Practice Address - Phone:206-782-5789
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-14
Last Update Date:2015-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA18536225100000X
WAWA600819382251X0800X
WAPT601745662251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
001409801Medicare Oscar/Certification