MRS. JIMMA LANELLE LAKE, LPTA
Restorative Service Providers at Vintage Dr, Waxahachie, TX

License number
Texas 2012555
Category
Restorative Service Providers
Type
Physical Therapy Assistant
Address
Address 2
112 Vintage Dr, Waxahachie, TX 75165
PO Box 81, Richland, TX 76681
Phone
(214) 632-9075
(972) 923-0493 (Fax)
(903) 362-4012
National Provider ID: 1992900336
LicenseFiles verified this license of Nov 7, 2017 at the National Plan and Provider Enumeration System.

Personal information

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Name
Address
Phone
Jimma Lake
PO Box 81, Richland, TX 76681

Restorative Service Providers licenses in Texas