Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | 18536 | MA |
N | 2251X0800X | Physical Therapist - Orthopedic | PT60174566 | WA |
Y | 2251X0800X | Physical Therapist - Orthopedic | WA60081938 | WA |
NPI | 1013242734 |
---|---|
Provider Name | Aimee Lake |
First Address | Seattle, WA 98103-3684 |
Second Address | Seattle, WA 98103-3684 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/10/2009 |
Last Update Date | 13/10/2015 |