| NPI | 1003651217 |
|---|---|
| Doing Business As | LAKE RIDGE THERAPY |
| Entity Type | Organization |
| Authorized Contact | SOON BURNAM Treasurer 949-540-1249 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225800000X Recreation Therapist |
| Enumeration Date | 2024-06-28 |
| Last Update Date | 2024-06-28 |