Provider Demographics
NPI:1689187189
Name:LANE FAMILY WELLNESS CENTER, LLC.
Entity type:Organization
Organization Name:LANE FAMILY WELLNESS CENTER, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TOMMY
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:LANE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:813-968-4293
Mailing Address - Street 1:1323 W FLETCHER AVE STE A
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33612-3310
Mailing Address - Country:US
Mailing Address - Phone:813-968-4293
Mailing Address - Fax:813-968-3182
Practice Address - Street 1:1323 W FLETCHER AVE STE A
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-3310
Practice Address - Country:US
Practice Address - Phone:813-968-4293
Practice Address - Fax:813-968-3182
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-07
Last Update Date:2017-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty