Individual
PERRY LEE LAKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT/CMT
Contact information
Practice address
1101 S DAVID ST, SAN ANGELO, TX 76903-7249
(208) 241-1632
Mailing address
1101 S DAVID ST, SAN ANGELO, TX 76903-7249
(208) 241-1632
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
6711070-4701
UT
225700000X
Massage Therapist
MAS-3291
ID
225700000X
Massage Therapist
Primary
MT107775
TX
Other
Enumeration date
12/01/2021
Last updated
12/01/2021
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