MEDICARE: TANI JO LANE PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	02803	IA

General Provider Information

NPI Number	:	1013135276
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TANI JO LANE PT

Provider Business Mailing Address
First Line	:	1205 S 3RD ST
Second Line	:
City	:	MARSHALLTOWN
State	:	IA
Zip	:	50158-3936
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1307 S BROADWAY ST
Second Line	:
City	:	TOLEDO
State	:	IA
Zip	:	52342-2307
Country	:	US
Telephone Number	:	641-484-5253
Fax Number	:	641-484-5312

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/23/2007
Last Update Date	:	07/08/2007

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Directions to “ TANI JO LANE PT” Practice Location

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