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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