MEDICARE: SHELLEY KAY LANE PT

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	225100000X	Physical Therapist	1484	OK

General Provider Information

NPI Number	:	1528101797
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHELLEY KAY LANE PT

Provider Business Mailing Address
First Line	:	4009 W NASHVILLE ST
Second Line	:
City	:	BROKEN ARROW
State	:	OK
Zip	:	74012-4738
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4009 W NASHVILLE ST
Second Line	:
City	:	BROKEN ARROW
State	:	OK
Zip	:	74012-4738
Country	:	US
Telephone Number	:	918-252-2918
Fax Number	:

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

Provider Enumeration Date	:	02/15/2007
Last Update Date	:	07/08/2007

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Directions to “ SHELLEY KAY LANE PT” Practice Location

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