Kristy Ann Lake, MPT – Physical Therapist

Key facts

NPI: 1477579324
Entity type: Individual (NPI type 1)
Primary specialty: Physical Therapist 225100000X
License: PT21094 (FL)
Practice address: 4356 66TH St N
Kenneth City, FL 33709-4920
Phone: (727) 546-4700
Fax: (727) 549-8108
NPI assigned: Jul 14, 2006
Sex: Female
Sole proprietor: No

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Sports and Orthopedic Rehabilitation Services Inc Physical Therapy Clinic/Center · Riverview, FL · NPI 1841981073

NPD (past)

Medicare participation

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD): No

State licenses

License	State	Type	Specialty
PT21094	FL	MD	Physical Therapist

Practice roles (1 of 3)

Organization	Specialty	Status	New patients
Sports and Orthopedic Rehabilitation Services Inc		Past	Accepting new patients

Networks

Optimum HealthCare HMO Network
Freedom Health HMO Network

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Physical Therapist	225100000X	PT21094	FL	Yes

Addresses

Primary practice location

4356 66TH St N
Kenneth City, FL 33709-4920

Mailing address

470 3Rd St S
#613
St Petersburg, FL 33701-4649

Other providers in Kenneth City, FL

All providers in Kenneth City, FL · Physical Therapist in Florida

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 16, 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.

Verify at the official NPI Registry.