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General NPI Number Information
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NPI Number | 1679747422
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Entity Type | Individual
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Provider Name | DEBORAH JEAN LANE PT
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Gender | Female
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Dates
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Enumeration Date | 04/14/2008
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Last Update Date | 04/14/2008
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Provider Practice Location Address
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Address Line | 1983 PGA BLVD SUITE 105B
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City | PALM BEACH GARDENS
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State | FL
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Zip | 33408-3001
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Country | US
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Telephone | 561-799-0104
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Fax |
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Provider Business Mailing Address
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Address Line | 855 NIEMEN DR
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City | PALM BEACH GARDENS
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State | FL
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Zip | 33410-2163
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Country | US
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Telephone | 561-691-4635
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT2450
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License Number State | FL
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