Clear Lake Physical Therapy Inc
Organization Active NPI Physical Therapist · Lakeport, CA
NPI 1245295385 · NPPES record last updated Dec 1, 2009
Key facts
- NPI
- 1245295385
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Physical Therapist 225100000X
- License
- PT17230 (CA)
- Legal business name
- CLEAR LAKE PHYSICAL THERAPY INC
- Practice address
- 1173 11TH Street
Lakeport, CA 95453 - Phone
- (707) 263-1295
- Fax
- (707) 263-1295
- NPI assigned
- Apr 20, 2006
- Organization subpart
- No
Authorized official
- Name
- Lawrence Hosmer Hurst, PT
- Title
- Owner
- Phone
- (707) 263-1295
Practitioners 10
-
Matthew J. Garrean, P.T.
-
Deborah Thompson Hurst, P.T.
-
Arash Ray Maslehati, D.P.T.
-
Haijemyl Bawanan Velasco, D.P.T.
-
William Daniel Avery, DPT
-
Douglas Emerson, PT, DPT, OCS, CMP
-
Richard Allen Green, RPT
National Provider Directory
Locations
1173 Eleventh St
Lakeport, CA 95453
Phone (707) 263-1295
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist |
225100000X | PT17230 | CA | Yes |
Addresses
Primary practice location
1173 11TH Street
Lakeport, CA 95453
Mailing address
1173 11TH Street
Lakeport, CA 95453
Phone (707) 263-1295
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| GPT001040 | Medicaid | CA |
Other providers in Lakeport, CA
- Michelle Jean Champion
- Patricia Chandler
- Thonyoon Chao
- Christopher O. Torres, DDS, P.C.
- Bradley Trent Clair
- Brittany Renee Cole
- Ebony Denise Coleman
- Tessy Cook
- Tara Cossey
- County of Lake
All providers in Lakeport, CA · Physical Therapist in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 1, 2009. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.