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Organization
LEMUEL C & ELMEZEN MARTIN
Active
Organization
LEMUEL C & ELMEZEN MARTIN
Active
Other names
Quail Run Physical Therapy
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LEMUEL CAMPOMANES MARTIN PT (PHYSICAL THERAPIST OWNER)
(707) 263-6845
Entity
Organization
Contact information
Practice address
422 LAKEPORT BLVD, LAKEPORT, CA 95453-5404
(707) 263-6845
(707) 263-6451
Mailing address
PO BOX 1560, LAKEPORT, CA 95453-1560
(707) 263-6845
(707) 263-6451
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT11399
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ZZZ06870Z
MEDICARE PTAN
CA
Enumeration date
12/12/2006
Last updated
07/16/2015
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