Organization
CLEAR LAKE PHYSICAL THERAPY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LAWRENCE HOSMER HURST PT (OWNER)
(707) 263-1295
Entity
Organization
Contact information
Practice address
1173 11TH STREET, LAKEPORT, CA 95453
(707) 263-1295
(707) 263-1295
Mailing address
1173 11TH STREET, LAKEPORT, CA 95453
(707) 263-1295
(707) 263-1295
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT17230
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GPT001040
—
CA
Enumeration date
04/20/2006
Last updated
12/01/2009
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