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Jack Lane, PTA
NPI 1275902520 · on the registry since 2015 · sole proprietor
Practice
- Address
- 615 29th St
Lewiston, ID 83501 - Phone
- (208) 985-4722
Registry record
- Primary taxonomy
- 314000000X
314000000X
- Licence states on file
- ID
From the registry's licence fields, which are often incomplete.
- Sex
- Male
- Record last updated
- 2015-09-16
Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Idaho