Most Relevant Information
Provider Data
| NPI Number: | 1003305319 |
| Provider Name: | AUSTIN MICHAEL LAKE PT, DPT |
| Entity Type: | Individual |
| Taxonomy Code: | 225100000X |
| Specialty: | Physical Therapist |
| License Number: | 14911 |
Most Important Dates
| Enumeration Date: | 05/02/2018 |
| Last Updated: | 03/04/2020 |
Provider Practice Location
4681 W 20TH ST UNIT 202B
GREELEY
CO
80634
Practice Location Phone/Fax
| Phone: | 7203313687 |
| Fax: |
Provider Mailing Location
2212 34TH AVE
GREELEY
CO
806347547
Provider Mailing Phone/Fax
| Phone: | 7203313687 |
| Fax: |