Individual
KENYA LOUISE LAKES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1029 E 5TH ST, CONNERSVILLE, IN 47331-3301
(765) 825-0543
Mailing address
101 E STATE ST, KENNETT SQUARE, PA 19348-3109
(855) 492-8878
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
06004517A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
06004517A
INDIANA PROFESSIONAL LICENSING AGENCY
IN
Enumeration date
10/16/2013
Last updated
10/16/2013
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