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
14855 OLYMPIC DR, CLEARLAKE, CA 95422-9522
(707) 994-7248
(707) 994-7248
Mailing address
14855 OLYMPIC DR, PO BOX 3288, CLEARLAKE, CA 95422-9522
(707) 994-7248
(707) 994-7248
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
05/10/2006
Last updated
12/07/2009
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