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Stacy Lake, ATC
NPI 1912274663 · on the registry since 2011
Practice
- Address
- 14730 Pulver Rd
Fort Wayne, IN 46845 - Phone
- (260) 413-6770
Registry record
- Primary taxonomy
- Athletic Trainer
2255A2300X
- Licence states on file
- IN
From the registry's licence fields, which are often incomplete.
- Sex
- Female
- Record last updated
- 2011-11-23
Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Indiana