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General NPI Number Information
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NPI Number | 1588809461
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Entity Type | Organization
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Legal Business Name | LAKEWAY PHYSICAL THERAPY OUTPATIENT, PLLC
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Dates
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Enumeration Date | 12/08/2008
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Last Update Date | 03/19/2012
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Provider Practice Location Address
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Address Line | 402-C CHURCH ST.
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City | DOVER
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State | TN
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Zip | 37058
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Country | US
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Telephone | 931-232-4555
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Fax | 931-232-4599
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Provider Business Mailing Address
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Address Line | 75 CASTLETON CV
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City | PARIS
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State | TN
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Zip | 38242-5942
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Country | US
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Telephone | 931-232-4555
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. JOSELITO PASAOL
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Credential | PT
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Telephone | 931-232-4555
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 0590012
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License Number State | TN
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