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General NPI Number Information
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NPI Number | 1538358585
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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 | 10/16/2007
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Last Update Date | 08/20/2025
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Provider Practice Location Address
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Address Line | 4423 NW 6TH PL STE C
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City | GAINESVILLE
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State | FL
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Zip | 32607-6116
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Country | US
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Telephone | 352-325-2276
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Fax | 352-877-4580
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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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