Provider Demographics
NPI:1154594869
Name:LANE, DONNA MICHELLE (PT)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:MICHELLE
Last Name:LANE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:DONNA
Other - Middle Name:MICHELLE
Other - Last Name:GHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:1111 CHURCH AVE
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:IN
Mailing Address - Zip Code:47546-3761
Mailing Address - Country:US
Mailing Address - Phone:812-634-7750
Mailing Address - Fax:
Practice Address - Street 1:1111 CHURCH AVE
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:IN
Practice Address - Zip Code:47546-3761
Practice Address - Country:US
Practice Address - Phone:812-634-7750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-02
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05003328A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist