Healthcare Provider Details

I. General information

NPI: 1235103169
Provider Name (Legal Business Name): ALISON J LANE MS, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2006
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2817 ROCK MERRITT AVE (WOMAC ARMY MED CTR) 108 ADA BDE H2F PROGRAM
FORT BRAGG NC
28310
US

IV. Provider business mailing address

3717 COLUMBIA PIKE
ARLINGTON VA
22204-4255
US

V. Phone/Fax

Practice location:
  • Phone: 910-570-3345
  • Fax:
Mailing address:
  • Phone: 703-575-8400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number36002374A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: