# PARK LAKE PHYSICAL MEDICINE, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Integrative Physical Medicine
- **Organization subpart:** No

## Provider details

- **NPI number:** 1669749396
- **Authorized official:** MRS. SHELBY ANNE REID (MANAGER)
- **Authorized official phone:** (407) 839-1045

## Contact information

- **Practice address:** 2206 E COLONIAL DR, ORLANDO, FL 32803-4912
- **Practice address phone:** (407) 839-1045
- **Practice address fax:** (407) 839-1044
- **Mailing address:** 2206 E COLONIAL DR, ORLANDO, FL 32803-4912
- **Mailing address phone:** (407) 839-1045
- **Mailing address fax:** (407) 839-1044

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | NULL | Yes |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | — | Yes |

## Other

- **Enumeration date:** 11/23/2011
- **Last updated:** 03/19/2014