Lakeway Physical Therapy Outpatient, PLLC

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

License

0590012 Issued in TN

Legal business name

LAKEWAY PHYSICAL THERAPY OUTPATIENT, PLLC

Practice address

402-C Church St.
Dover, TN 37058

Phone

(931) 232-4555

Fax

(931) 232-4599

NPI assigned

Dec 8, 2008

Last updated

Mar 19, 2012By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Joselito Pasaol, PTNPI 1487894028

Title

President

Phone

(931) 232-4555

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in TN

Enrollment records 1

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Richard Mata Abad, P.T.

  • Physical Therapist
  • Martin, TN
  • NPI 1396984175
  Medicare reassignment Care Compare group NPD
• Faustino H. Garcia Jr., PHYSICAL THERAPIST

  • Rehabilitation Hospital
  • Martin, TN
  • NPI 1881842607
  Medicare reassignment Care Compare group NPD
• Joselito A Pasaol, PT

  • Physical Therapist
  • Dover, TN
  • NPI 1487894028
  Authorized official Same address or phone

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1228694400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1332115200000",
    "number": "1588809461",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "75 CASTLETON CV",
            "city": "PARIS",
            "state": "TN",
            "postal_code": "382425942",
            "telephone_number": "931-232-4555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "402-C CHURCH ST.",
            "city": "DOVER",
            "state": "TN",
            "postal_code": "37058",
            "telephone_number": "931-232-4555",
            "fax_number": "931-232-4599"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKEWAY PHYSICAL THERAPY OUTPATIENT, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-12-08",
        "last_updated": "2012-03-19",
        "status": "A",
        "authorized_official_last_name": "PASAOL",
        "authorized_official_first_name": "JOSELITO",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "931-232-4555",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "TN",
            "license": "0590012",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1523011",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Daniel Earl Hinderliter
• Price Edwin Hopson Jr., DDS
• Tamara Hughes, RN
• John J Maria OD PC
• Tammy Lagan, OTR
• Briana Lancaster, SLP
• Cindy Leach, MSSW
• Beverly Lynn Lewis, MASTER OF SCIENCE
• Lovin, Inc.
• John A Lovin, D.C.

• Physical Therapy Clinic/Center in Dover, TN
• Providers in Dover, TN by specialty
• Physical Therapy Clinic/Center in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.