Individual
EMILY LAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
1411 S CREASY LN STE 100, LAFAYETTE, IN 47905-7433
(765) 447-5552
(765) 449-1054
Mailing address
PO BOX 4699, LAFAYETTE, IN 47903-4699
(765) 446-5417
(765) 446-5317
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
06006130A
IN
225200000X
Physical Therapy Assistant
Primary
53781
CA
Other
Enumeration date
07/23/2020
Last updated
07/01/2025
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