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NPI Code Detail

MEDICARE: AIMEE LAKE DPT

MEDICARE: AIMEE LAKE DPT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist18536MA
22251X0800XOrthopedic Physical TherapistWA60081938WA
32251X0800XOrthopedic Physical TherapistPT60174566WA

General Provider Information

NPI Number : 1013242734
Entity Type Code : Individual
Provider Name (Legal Business Name) : AIMEE LAKE DPT
Provider Business Mailing Address
First Line : 8750 GREENWOOD AVE N STE S1
Second Line :
City : SEATTLE
State : WA
Zip : 98103-3684
Country : US
Telephone Number : 206-782-5789
Fax Number :
Provider Business Practice Location Address
First Line : 8750 GREENWOOD AVE N STE S1
Second Line :
City : SEATTLE
State : WA
Zip : 98103-3684
Country : US
Telephone Number : 206-782-5789
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/14/2009
Last Update Date : 10/13/2015

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Directions to “ AIMEE LAKE DPT” Practice Location

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