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General NPI Number Information
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NPI Number | 1245235183
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Entity Type | Organization
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Legal Business Name | HEALTHWORKS OF LAKE CITY, INC.
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Dates
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Enumeration Date | 06/16/2005
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Last Update Date | 01/12/2012
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Provider Practice Location Address
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Address Line | 1206 SW MAIN BLVD STE 101
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City | LAKE CITY
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State | FL
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Zip | 32025-6684
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Country | US
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Telephone | 386-752-1652
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Fax | 386-752-0939
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Provider Business Mailing Address
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Address Line | 1206 SW MAIN BLVD STE 101
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City | LAKE CITY
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State | FL
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Zip | 32025-6684
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Country | US
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Telephone | 386-752-1652
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Fax | 386-752-0939
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Authorized Official
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Title or Position | OWNER/ADMINISTRATOR
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Name | MICHAEL A BEARDSLEY
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Credential | PT
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Telephone | 386-752-1652
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | PT17329
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License Number State | FL
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