Quail Run Physical Therapy | |
422 Lakeport Blvd, Lakeport, CA 95453-5404 | |
(707) 263-6845 | |
(707) 263-6451 |
Full Name | Quail Run Physical Therapy |
---|---|
Type | Facility |
Speciality | Physical Therapist |
Location | 422 Lakeport Blvd, Lakeport, California |
Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1477614741 | NPI | - | NPPES |
ZZZ06870Z | Other | CA | MEDICARE PTAN |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
225100000X | Physical Therapist | PT11399 (California) | Primary |
Provider Name | Lemuel C Martin |
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Provider Type | Practitioner - Physical Therapist In Private Practice |
Provider Identifiers | NPI Number: 1083622039 PECOS PAC ID: 4284731324 Enrollment ID: I20080327000339 |
Mailing Address | Practice Location Address |
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Quail Run Physical Therapy Po Box 1560, Lakeport, CA 95453-1560 Ph: (707) 263-6845 | Quail Run Physical Therapy 422 Lakeport Blvd, Lakeport, CA 95453-5404 Ph: (707) 263-6845 |
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 | |
Clear Lake Physical Therapy Inc Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 1173 11th Street, Lakeport, CA 95453 Phone: 707-263-1295 Fax: 707-263-1295 | |
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 |