Individual
DAVID R LAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
8917 S 77TH ST, FRANKLIN, WI 53132-9784
(414) 698-3730
Mailing address
8917 S 77TH ST, FRANKLIN, WI 53132-9784
(414) 698-3730
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Enumeration date
02/14/2011
Last updated
01/26/2015
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