MEDICARE: LAKE MILLS PHYSICAL THERAPY LLC

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
1	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1295138436
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAKE MILLS PHYSICAL THERAPY LLC

Provider Business Mailing Address
First Line	:	115 N MILL ST
Second Line	:
City	:	LAKE MILLS
State	:	IA
Zip	:	50450-1303
Country	:	US
Telephone Number	:	641-592-3500
Fax Number	:	712-546-1770

Provider Business Practice Location Address
First Line	:	115 N MILL ST
Second Line	:
City	:	LAKE MILLS
State	:	IA
Zip	:	50450-1303
Country	:	US
Telephone Number	:	641-592-3500
Fax Number	:	712-250-2415

Authorized Official
Title or Position	:	MANAGER
Name	:	AMY M SCHURMAN
Credential	:
Telephone Number	:	712-301-6262

Provider Enumeration Date	:	10/02/2014
Last Update Date	:	04/08/2022

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