=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942249602
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CATHERINE S LANE PT, DPT, MS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/06/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 653 SUMMER ST SECOND FLOOR
-----------------------------------------------------
City | BOSTON
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02210-2108
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 617-269-6262
-----------------------------------------------------
Fax | 617-269-1068
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 33 POND AVE APT. 821
-----------------------------------------------------
City | BROOKLINE
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02445-7163
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 617-899-5977
-----------------------------------------------------
Fax | 617-731-9175
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 1984
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------