Cody Garrett Lake, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

Practice address

433 E State Highway 152
Mustang, OK 73064-4519

Phone

(405) 353-2159

NPI assigned

Oct 8, 2020

Last updated

Nov 17, 2020By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in OK

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

PTMS 3.0 LLCGroup PAC ID 2365768231, 115 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

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.

• PTMS 3.0, LLC

  dba Physical Therapy Central

  • Physical Therapist
  • Norman, OK
  • NPI 1942690375
  Medicare reassignment Care Compare group NPD
• Oklahoma Luna Care Physical Therapy LLC

  • Physical Therapist
  • Oklahoma City, OK
  • NPI 1306572508
  Medicare reassignment NPD
• Precision Physical Therapy LLC

  • Physical Therapist
  • Harrah, OK
  • NPI 1578675070
  Medicare reassignment NPD
• PTMS 3.0, LLC

  dba Physical Therapy Central of Choctaw

  • Physical Therapist
  • Choctaw, OK
  • NPI 1316024441
  NPD
• PTMS 3.0, LLC

  dba Physical Therapy Central of Bethany

  • Physical Therapist
  • Bethany, OK
  • NPI 1972056786
  NPD

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

{
    "created_epoch": "1602115200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1605571200000",
    "number": "1841897253",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "440 MERCHANT DR",
            "city": "NORMAN",
            "state": "OK",
            "postal_code": "730696470",
            "telephone_number": "405-809-8713"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "433 E STATE HIGHWAY 152",
            "city": "MUSTANG",
            "state": "OK",
            "postal_code": "730644519",
            "telephone_number": "405-353-2159"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "800 Garth Brooks Blvd",
            "address_purpose": "LOCATION",
            "city": "Yukon",
            "state": "OK",
            "postal_code": "730993841",
            "country_code": "US",
            "telephone_number": "405-350-3336",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LAKE",
        "first_name": "CODY",
        "middle_name": "GARRETT",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-10-08",
        "last_updated": "2020-11-17",
        "certification_date": "2020-11-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PT LICENSE",
            "identifier": "5896",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Crystal Gail Kinzalow-Hardimon, APRN, FNP-C
• Heather Renee Koch, D.D.S
• Kristi Cobb DDS
• Kylar Kurtz
• Adam Lagaly, RN
• Emily P Lambkin, DC
• Brian Scott Lancaster
• Kyndall Langford
• Zachary Laster
• Brian Christopher Lee, COTA/L

• Physical Therapist in Mustang, OK
• Providers in Mustang, OK by specialty
• Physical Therapist in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2020; 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.