Warren James Lake, P.T.

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

8589 Issued in AZ

Practice address

1530 W Glendale Ave
Suite 101
Phoenix, AZ 85021-8578

Phone

(602) 242-1909

Fax

(877) 375-0934

NPI assigned

Aug 4, 2009

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• Neurologic Therapy Specialists LLC

  • Physical Therapy Clinic/Center
  • Phoenix, AZ
  • NPI 1386721512

  Physical Therapist

  NPD
• Wing Neurological Rehabilitation

  • Physical Therapist
  • Phoenix, AZ
  • NPI 1801840897
  NPD (past)

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

{
    "created_epoch": "1249344000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1330387200000",
    "number": "1659502979",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8993 W IRMA LN",
            "city": "PEORIA",
            "state": "AZ",
            "postal_code": "853826479",
            "telephone_number": "801-916-0030"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1530 W GLENDALE AVE",
            "address_2": "SUITE 101",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850218578",
            "telephone_number": "602-242-1909",
            "fax_number": "877-375-0934"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LAKE",
        "first_name": "WARREN",
        "middle_name": "JAMES",
        "name_prefix": "Mr.",
        "credential": "P.T.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-08-04",
        "last_updated": "2012-02-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "AZ",
            "license": "8589",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lake Mi Mobile Doctors, P.C.
• Lake Pleasant Surgical Center LLC
• Herbert Vincent Lake, D.C.
• Melissa Lake, LAC
• Melissa Ann Lake, PSY.D.
• Briana Danyelle Lakebrink, ATC, ITAT
• Lakeside ABA Az LLC
• Marica Laketic, PHARMD
• Sofia Lakhdar, MD
• Howard Lakritz, M.D.

• Physical Therapist in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Physical Therapist in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.