Healthcare Provider Details

I. General information

NPI: 1013242734
Provider Name (Legal Business Name): AIMEE LAKE DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2009
Last Update Date: 10/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8750 GREENWOOD AVE N STE S1
SEATTLE WA
98103-3684
US

IV. Provider business mailing address

8750 GREENWOOD AVE N STE S1
SEATTLE WA
98103-3684
US

V. Phone/Fax

Practice location:
  • Phone: 206-782-5789
  • Fax:
Mailing address:
  • Phone: 206-782-5789
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number18536
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberWA60081938
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT60174566
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: