Provider Demographics
NPI:1679747422
Name:LANE, DEBORAH JEAN (PT)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:JEAN
Last Name:LANE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:855 NIEMEN DR
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-2163
Mailing Address - Country:US
Mailing Address - Phone:561-691-4635
Mailing Address - Fax:
Practice Address - Street 1:1983 PGA BLVD
Practice Address - Street 2:SUITE 105B
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33408-3001
Practice Address - Country:US
Practice Address - Phone:561-799-0104
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-14
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT2450225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist