Healthcare Provider Details

I. General information

NPI: 1619419579
Provider Name (Legal Business Name): DANI M LANE PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2016
Last Update Date: 11/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

414 W SUNSET RD SUITE 110
SAN ANTONIO TX
78209-1756
US

IV. Provider business mailing address

414 W SUNSET RD SUITE 110
SAN ANTONIO TX
78209-1756
US

V. Phone/Fax

Practice location:
  • Phone: 210-828-7557
  • Fax:
Mailing address:
  • Phone: 210-828-7557
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number1277735
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number1277735
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: