JEREMY MICHAEL LAKE

FORT WORTH, TX
NPI1043849813
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy225100000X Physical Therapist
(Licence: TX  1143444)
Enumeration Date2020-04-03
Last Update Date2020-04-03
Business Address
JEREMY MICHAEL LAKE PT
6601 HARRIS PKWY
FORT WORTH, TX 76132-6108
Phone number: 817-738-9866
Mailing Address
JEREMY MICHAEL LAKE PT
1713 GRIFFIN LN
MANSFIELD, TX 76063-8563
Phone number: 817-881-1545
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