MEDICARE: MR. LANE ALEXANDER LMT, MMP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	3881	KY

General Provider Information

NPI Number	:	1417252065
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. LANE ALEXANDER LMT, MMP

Provider Business Mailing Address
First Line	:	2301 HURSTBOURNE VILLAGE DR STE 700
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40299-1849
Country	:	US
Telephone Number	:	502-994-9096
Fax Number	:

Provider Business Practice Location Address
First Line	:	4800 SHERBURN LN
Second Line	:	SUITE C
City	:	LOUISVILLE
State	:	KY
Zip	:	40207-4197
Country	:	US
Telephone Number	:	502-994-9096
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/12/2011
Last Update Date	:	06/06/2021

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