MEDICARE: NICHALAS FRANCIS LANE DPT

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	8755	AZ
2	2251S0007X	Sports Physical Therapist
3	2251X0800X	Orthopedic Physical Therapist

General Provider Information

NPI Number	:	1639407752
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICHALAS FRANCIS LANE DPT

Provider Business Mailing Address
First Line	:	5111 N SCOTTSDALE RD
Second Line	:	SUITE 100
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85250-7075
Country	:	US
Telephone Number	:	480-990-1379
Fax Number	:	480-423-8458

Provider Business Practice Location Address
First Line	:	5111 N SCOTTSDALE RD
Second Line	:	SUITE #100
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85250-7075
Country	:	US
Telephone Number	:	480-990-1379
Fax Number	:	480-423-8458

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

Provider Enumeration Date	:	12/01/2009
Last Update Date	:	11/30/2012

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