Provider Demographics
NPI:1285241182
Name:LANE, VANESSA RENEE (PT, DPT)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:RENEE
Last Name:LANE
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 601791
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-1791
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6667 VERNON WOODS DR STE A14
Practice Address - Street 2:
Practice Address - City:SANDY SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30328-3236
Practice Address - Country:US
Practice Address - Phone:336-718-6931
Practice Address - Fax:336-718-3389
Is Sole Proprietor?:No
Enumeration Date:2020-09-25
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP20567225100000X
GAPT014785225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist