Individual
CARTER A LAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
1020 S MAIN ST, MILTON FREEWATER, OR 97862-1534
(509) 588-2924
(509) 588-4564
Mailing address
824 W LEWIS ST STE 204, PASCO, WA 99301-5561
(509) 544-0265
(509) 544-0304
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
4916
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0196934
DEPT LABOR & INDUSTRIES
WA
05
—
269798
—
OR
Enumeration date
12/22/2006
Last updated
10/03/2007
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