| Organization Name: | LAKEPORT PHYSICAL THERAPY, INC. |
| NPI Number: | 1386988970 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | LAWRENCE H HURST (MANAGER) |
| Mailing Address: | 381 Lakeport Blvd Lakeport |
| State: | CA US |
| Postal Code: | 954535412 |
| Phone Number: | 7072635210 |
| Fax Number: | 7072638045 |
| NPI Enumeration Date: | 11/20/2012 |
| NPI Last Update Date: | 11/20/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | PT17230 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |