MR. Jack Lane IV, PTA
NPI #1275902520 in Lewiston, Idaho
Provider Information
- NPI Number
- 1275902520
- Entity Type
- Individual
- Name
- MR. Jack Lane IV, PTA
- Gender
- Not Specified
- Sole Proprietor
- Yes
- Primary Specialty
- Skilled Nursing Facility
- Credential
- PTA
- Enumeration Date
- Sep 16, 2015
- Last Updated
- Sep 16, 2015
Practice Location
Specialties & Taxonomy Codes
| Specialty |
|---|
| Skilled Nursing Facility |
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