Mary Katherine M Lake, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

2925 Issued in NH

Practice address

458 Old Street Rd
Peterborough, NH 03458-1265

Phone

(603) 924-4635

Fax

(603) 924-4634

NPI assigned

May 29, 2009

Last updated

May 29, 2009By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Mary Kaye Lake Other name

Medicare fee-for-service enrollment

Enrolled in NH

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 1995

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Healthpro Heritage Rehab and Fitness LLCGroup PAC ID 6507832573, 976 clinicians

Practice addresses (Care Compare)

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Healthpro Heritage Rehab & Fitness, LLC

  • Physical Therapist
  • Peterborough, NH
  • NPI 1679948657
  Medicare reassignment Care Compare group NPD
• Healthpro Heritage Rehab & Fitness, LLC

  • Physical Therapist
  • Independence, MO
  • NPI 1871072462
  NPD

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

{
    "created_epoch": "1243555200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1243555200000",
    "number": "1700012168",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "458 OLD STREET RD",
            "city": "PETERBOROUGH",
            "state": "NH",
            "postal_code": "034581265",
            "telephone_number": "603-924-4635",
            "fax_number": "603-924-4634"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "458 OLD STREET RD",
            "city": "PETERBOROUGH",
            "state": "NH",
            "postal_code": "034581265",
            "telephone_number": "603-924-4635",
            "fax_number": "603-924-4634"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LAKE",
        "first_name": "MARY KATHERINE",
        "middle_name": "M",
        "credential": "PT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-05-29",
        "last_updated": "2009-05-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NH",
            "license": "2925",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARY KAYE",
            "last_name": "LAKE",
            "credential": "PT",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Bonnieta Melodie Kraft, NCSP
• Jonathan D. Krant, MD
• Gregory Kriebel, MD
• John P Labranche, MD
• Brittany Anne Labrecque, BA, MS
• Karen L Langley, LICSW
• Stacey A Lanza Roberts, LCMHC, MLADC
• Lara Kroodsma, PSYD, PLLC
• Abby A Larock, OT
• Amy Beth Lashua, B.S.

• Physical Therapist in Peterborough, NH
• Providers in Peterborough, NH by specialty
• Physical Therapist in New Hampshire

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.