Individual
LAURIE ANN LAKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
1600 SPRINGDALE ST, LONGVIEW, TX 75604-2635
(903) 757-5364
Mailing address
1600 SPRINGDALE ST, LONGVIEW, TX 75604-2635
(903) 757-5364
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MT004607
TX
Other
Enumeration date
06/27/2011
Last updated
06/27/2011
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