Stephen Taylor Lake, MPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

3705 Issued in TN

Practice address

4957 Swinyar Dr Ste 103
Ooltewah, TN 37363-2205

Phone

(423) 664-0800

Fax

(423) 664-0801

NPI assigned

May 26, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Agilitas USA, Inc

  • Physical Therapy Clinic/Center
  • Chattanooga, TN
  • NPI 1194109025
  NPD (past)
• Chattanooga Spine & Sport

  • Physical Therapist
  • Chattanooga, TN
  • NPI 1700055977
  NPD (past)
• Summit Physical Therapy

  • Physical Therapist
  • Hixson, TN
  • NPI 1225514110
  NPD (past)

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

{
    "created_epoch": "1148601600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1540857600000",
    "number": "1689620106",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 CRESCENT CENTRE DR STE 600",
            "city": "FRANKLIN",
            "state": "TN",
            "postal_code": "370677286",
            "telephone_number": "615-373-1350",
            "fax_number": "615-221-9054"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4957 SWINYAR DR STE 103",
            "city": "OOLTEWAH",
            "state": "TN",
            "postal_code": "373632205",
            "telephone_number": "423-664-0800",
            "fax_number": "423-664-0801"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1736 Gunbarrel Rd Ste B",
            "address_purpose": "LOCATION",
            "city": "Chattanooga",
            "state": "TN",
            "postal_code": "37421",
            "country_code": "US",
            "telephone_number": "423-894-9893",
            "fax_number": "423-894-0992",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1736 Gunbarrel Rd Ste B",
            "address_purpose": "LOCATION",
            "city": "Chattanooga",
            "state": "TN",
            "postal_code": "37421",
            "country_code": "US",
            "telephone_number": "423-894-9893",
            "fax_number": "423-894-0992",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LAKE",
        "first_name": "STEPHEN",
        "middle_name": "TAYLOR",
        "credential": "MPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-26",
        "last_updated": "2018-10-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "TN",
            "license": "3705",
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "GA",
            "license": "PT004097",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0446652",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBST - GROUP NUMBER",
            "identifier": "3156797",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5441437",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kopek Chiropractic and Wellness
• Alex Brian Kopek, DC
• Guerdon Maurice Kopp, DPH
• Sarah Janet Kyle, R.N.
• Sherilyn Lacy, PC
• Deyonna J'Nae Lansden
• Julia Lanza, COTA
• Corrie Martin Large, PT, DPT
• Mark Wayne Larson, MT
• Lawrence Associates Corp

• Physical Therapist in Ooltewah, TN
• Providers in Ooltewah, TN by specialty
• Physical Therapist in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2018; 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.