Organization
LAKE COUNTRY PHYSICAL THERAPY LLC
Active
Organization
LAKE COUNTRY PHYSICAL THERAPY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CHARLES RICHARD EISELE P.T. (PHYSICAL THERAPIST)
(706) 473-2348
Entity
Organization
Contact information
Practice address
121 SEBASTIAN DR, EATONTON, GA 31024-5750
(706) 473-2348
Mailing address
121 SEBASTIAN DR, EATONTON, GA 31024-5750
(706) 473-2348
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT004255
GA
Other
Enumeration date
07/15/2013
Last updated
07/15/2013
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