Jeff S Lane, PTA
Individual provider Active NPI Physical Therapy Assistant · Anmore, WV
NPI 1003500802 · NPPES record last updated Jun 5, 2023
Key facts
- NPI
- 1003500802
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapy Assistant 225200000X
- License
- 000946 (WV)
- Practice address
- 67 Casino Drive
Suite 104
Anmore, WV 26323 - Phone
- (304) 622-2684
- NPI assigned
- Jun 5, 2023
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 000946 | WV | MD | Physical Therapy Assistant |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | 000946 | WV | Yes |
Addresses
Primary practice location
67 Casino Drive
Suite 104
Anmore, WV 26323
Mailing address
5320 Georgetown Rd
Horner, WV 26372-9687
Phone (304) 517-0271
Other providers in Anmore, WV
All providers in Anmore, WV · Physical Therapy Assistant in West Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 5, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.