Lake, Stephen Taylor

Lake, Stephen Taylor is an individual health care provider with primary practice located at 4957 Swinyar Dr Ste 103 , Ooltewah TN 37363-2205. He recently has only one registered license in Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist, which is considered as his primary health care specialty. Lake, Stephen Taylor can be contacted via phone (423) 664-0800.

Contact Information

Primary practice address
4957 Swinyar Dr Ste 103 Ooltewah TN 37363-2205
Phone: (423) 664-0800
Fax: (423) 664-0801
Website:
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Health care specialties

SpecialtyCodeLicense #State
Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist 225100000X 3705 Tennessee
Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist 225100000X PT004097 Georgia

Profile Details

NPI number 1689620106
LBN Legal business name Lake, Stephen Taylor
Credentials Master of Physical Therapy (MPT)
Entity Individual
Sole proprietor 1 No
Enumeration date May 26th, 2006
Last updated Oct 30th, 2018 - about 6 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1689620106 NPPES
Tennessee MEDICAID 0446652
Tennessee Other 3156797
Tennessee MEDICAID 5441437

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