Healthcare Provider Details

I. General information

NPI: 1538417233
Provider Name (Legal Business Name): LAKE HEALTH & REHAB, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2012
Last Update Date: 12/09/2022
Certification Date: 12/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

306 STONER LOOP STE 3
LAKESIDE MT
59922-8601
US

IV. Provider business mailing address

PO BOX 5718
KALISPELL MT
59903-5718
US

V. Phone/Fax

Practice location:
  • Phone: 406-844-0744
  • Fax: 406-844-0759
Mailing address:
  • Phone: 406-756-0134
  • Fax: 406-309-2579

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: MR. BLAINE STIMAC
Title or Position: MANAGING MEMBER
Credential: PT
Phone: 406-756-1128