Provider Demographics
NPI:1063560142
Name:HALE, LANCE
Entity type:Individual
Prefix:
First Name:LANCE
Middle Name:
Last Name:HALE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3111 SHADY RIDGE TRL
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-4880
Mailing Address - Country:US
Mailing Address - Phone:281-491-6471
Mailing Address - Fax:832-223-3001
Practice Address - Street 1:3111 SHADY RIDGE TRL
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-4880
Practice Address - Country:US
Practice Address - Phone:281-491-6471
Practice Address - Fax:832-223-3001
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT16192255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer