Individual
MISS ELIZABETH LAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
101 E STATE ST, KENNETT SQUARE, PA 19348-3109
(410) 326-8156
Mailing address
13530 OSPREY LN, P.O. BOX 209, DOWELL, MD 20629-3016
(410) 610-8251
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
A4146
MD
Other
Enumeration date
07/28/2014
Last updated
07/28/2014
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