Healthcare Provider Details

I. General information

NPI: 1861692790
Provider Name (Legal Business Name): ELIZABETH CHRISTIANNE LANE P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2007
Last Update Date: 07/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 PEACHTREE ST NE SUITE 1020
ATLANTA GA
30308-2247
US

IV. Provider business mailing address

1153 SHEPHERS LANE NE
ATLANTA GA
30324
US

V. Phone/Fax

Practice location:
  • Phone: 404-874-3467
  • Fax: 404-874-5858
Mailing address:
  • Phone: 678-787-5244
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT009112
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: