Provider Demographics
NPI:1679813166
Name:LAKES PHYSICAL THERAPY, PC
Entity type:Organization
Organization Name:LAKES PHYSICAL THERAPY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:DANNEKER
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:760-946-0044
Mailing Address - Street 1:18564 HIGHWAY 18
Mailing Address - Street 2:SUITE 302
Mailing Address - City:APPLE VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92307-2340
Mailing Address - Country:US
Mailing Address - Phone:760-946-0044
Mailing Address - Fax:760-946-0040
Practice Address - Street 1:18564 HIGHWAY 18
Practice Address - Street 2:SUITE 302
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92307-2340
Practice Address - Country:US
Practice Address - Phone:760-946-0044
Practice Address - Fax:760-946-0040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-21
Last Update Date:2013-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty