Healthcare Provider Details

I. General information

NPI: 1285831842
Provider Name (Legal Business Name): LANE KEYES BELANGIA PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1451 GAMBIER RD
MOUNT VERNON OH
43050-9112
US

IV. Provider business mailing address

21301 COUNTY ROAD 18
WALHONDING OH
43843-9717
US

V. Phone/Fax

Practice location:
  • Phone: 740-502-0693
  • Fax:
Mailing address:
  • Phone: 740-327-2402
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number03394
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: