Healthcare Provider Details

I. General information

NPI: 1760346928
Provider Name (Legal Business Name): CASSIDY LANE DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2025
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

157 ROSS CARTER BLVD
DUFFIELD VA
24244-5116
US

IV. Provider business mailing address

1543 FOLEY DR
BIG STONE GAP VA
24219-2001
US

V. Phone/Fax

Practice location:
  • Phone: 276-431-2841
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305217477
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: