Provider Demographics
NPI:1205144672
Name:LAKE AREA THERAPY SERVICES,LLC
Entity type:Organization
Organization Name:LAKE AREA THERAPY SERVICES,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEMBER
Authorized Official - Prefix:MS
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:FOLSTED
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:218-380-8010
Mailing Address - Street 1:PO BOX 266
Mailing Address - Street 2:
Mailing Address - City:MOOSE LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55767-0266
Mailing Address - Country:US
Mailing Address - Phone:218-380-8010
Mailing Address - Fax:
Practice Address - Street 1:88395 STURGEON ISLAND RD
Practice Address - Street 2:
Practice Address - City:STURGEON LAKE
Practice Address - State:MN
Practice Address - Zip Code:55783-3895
Practice Address - Country:US
Practice Address - Phone:218-380-8010
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-20
Last Update Date:2010-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2417225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty