Provider Demographics
NPI:1427486802
Name:LAKE ARROWHEAD PHYSICAL THERAPY
Entity type:Organization
Organization Name:LAKE ARROWHEAD PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF PHYSICAL THERAPY
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:COLE
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:909-337-0844
Mailing Address - Street 1:30948 ALL VIEW DR.
Mailing Address - Street 2:P.O. BOX 2951
Mailing Address - City:RUNNING SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92382-2951
Mailing Address - Country:US
Mailing Address - Phone:909-855-0861
Mailing Address - Fax:909-337-0045
Practice Address - Street 1:29099 HOSPITAL RD SUITE 106
Practice Address - Street 2:
Practice Address - City:LAKE ARROWHEAD
Practice Address - State:CA
Practice Address - Zip Code:92352-0070
Practice Address - Country:US
Practice Address - Phone:909-337-0844
Practice Address - Fax:909-337-0045
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MOUNTAINS COMMUNITY HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-10-23
Last Update Date:2013-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39415282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access