| Clear Lake Physical Therapy Inc | |
|
1173 11th Street, Lakeport, CA 95453 | |
| (707) 263-1295 | |
| (707) 263-1295 |
| Full Name | Clear Lake Physical Therapy Inc |
|---|---|
| Type | Facility |
| Speciality | Physical Therapist |
| Location | 1173 11th Street, Lakeport, California |
| Accepts Medicare Assignments | Does not participate in Medicare Program. The facility may not accept medicare assignment. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1245295385 | NPI | - | NPPES |
| GPT001040 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 225100000X | Physical Therapist | PT17230 (California) | Primary |
| Mailing Address | Practice Location Address |
|---|---|
| Clear Lake Physical Therapy Inc 1173 11th Street, Lakeport, CA 95453 Ph: (707) 263-1295 | Clear Lake Physical Therapy Inc 1173 11th Street, Lakeport, CA 95453 Ph: (707) 263-1295 |
Mr. Lemuel Campomanes Martin, PT Physical Therapist Medicare: Accepting Medicare Assignments Practice Location: 1281 Craig Avenue, Lakeport, CA 95453 Phone: 707-263-4564 Fax: 707-263-4572 | |
Aundrea Renee Tyner, P.T. Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 381 Lakeport Blvd, Lakeport, CA 95453 Phone: 707-263-5210 | |
Matthew J. Garrean, P.T. Physical Therapist Medicare: Medicare Enrolled Practice Location: 1281 Craig Ave, Lakeport, CA 95453 Phone: 707-263-4564 Fax: 707-263-4572 | |
Lakeport Physical Therapy, Inc. Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 381 Lakeport Blvd, Lakeport, CA 95453 Phone: 707-263-5210 Fax: 707-263-8045 | |
Quail Run Physical Therapy Physical Therapist Medicare: Medicare Enrolled Practice Location: 422 Lakeport Blvd, Lakeport, CA 95453 Phone: 707-263-6845 Fax: 707-263-6451 | |
Mr. Ildefonso Timple Campomanes Iii, P.T. Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 1281 Craig Ave, Lakeport, CA 95453 Phone: 707-263-4564 Fax: 707-263-4572 |