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Individual

MR. GARY WILLIAM LAKE

Active
Sole proprietor

Provider details

NPI number
Gender
Man
Credential
ATC

Contact information

Practice address
437 BARRENWOOD DR, WADSWORTH, OH 44281-1085
(330) 336-9398
Mailing address
437 BARRENWOOD DR, WADSWORTH, OH 44281-1085
(330) 336-9398

Taxonomy

Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT000402
OH

Other

Enumeration date
02/08/2006
Last updated
07/08/2007
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