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General NPI Number Information
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NPI Number | 1073801262
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Entity Type | Organization
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Legal Business Name | PRO MOTION THERAPY OF LAKE CITY LLC
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Dates
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Enumeration Date | 07/21/2011
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Last Update Date | 08/20/2025
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Provider Practice Location Address
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Address Line | 945 SW MAIN BLVD
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City | LAKE CITY
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State | FL
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Zip | 32025-5746
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Country | US
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Telephone | 386-755-3164
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Fax | 386-755-3165
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Provider Business Mailing Address
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Address Line | PO BOX 632670
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City | CINCINNATI
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State | OH
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Zip | 45263-2670
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Country | US
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Telephone | 702-818-5000
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Fax | 702-818-5001
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Authorized Official
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Title or Position | CHIEF CLINICAL OFFICER
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Name | ERIC ELDON DOUGLASS
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Credential |
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Telephone | 239-947-4184
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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