Individual
JENNIFER LAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPT, PT
Contact information
Practice address
112 HARCOURT RD, MOUNT VERNON, OH 43050-3946
(740) 392-8811
Mailing address
112 HARCOURT RD STE 1, MOUNT VERNON, OH 43050-3944
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
PT018511
OH
225100000X
Physical Therapist
Primary
PT018511
OH
Other
Enumeration date
03/11/2020
Last updated
04/08/2021
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