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General NPI Number Information
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NPI Number | 1104855261
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Entity Type | Organization
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Legal Business Name | LANE PHYSICAL THERAPY CENTER, INC
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Dates
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Enumeration Date | 07/01/2006
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Last Update Date | 11/01/2011
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Provider Practice Location Address
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Address Line | 3016 W. MAIN STREET SUITE 200
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City | RUSSELLVILLE
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State | AR
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Zip | 72801-2453
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Country | US
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Telephone | 479-967-9657
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Fax | 479-967-9658
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Provider Business Mailing Address
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Address Line | 3016 W. MAIN STREET SUITE 200
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City | RUSSELLVILLE
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State | AR
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Zip | 72801-2453
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Country | US
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Telephone | 479-967-9657
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Fax | 479-967-9658
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Authorized Official
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Title or Position | OFFICE ADMINISTRATOR
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Name | MONICA J CRAWFORD
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Credential |
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Telephone | 479-967-9657
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 1836
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License Number State | AR
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