Provider Demographics
NPI:1902964943
Name:LAK, MARCEL ROBERT (DPT)
Entity Type:Individual
Prefix:MR
First Name:MARCEL
Middle Name:ROBERT
Last Name:LAK
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1450 ELLIS ST
Mailing Address - Street 2:STE. 201
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-8812
Mailing Address - Country:US
Mailing Address - Phone:406-547-0122
Mailing Address - Fax:406-587-5548
Practice Address - Street 1:1532 ELLIS ST
Practice Address - Street 2:SUITE 103
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-8808
Practice Address - Country:US
Practice Address - Phone:406-586-5694
Practice Address - Fax:406-586-5987
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2013-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT4674225100000X
CAPT17531225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT17531Medicare PIN
MTPT17531Medicare PIN