Provider Demographics
NPI:1285875377
Name:LANE, VALERIE ANNE (PT)
Entity type:Individual
Prefix:
First Name:VALERIE
Middle Name:ANNE
Last Name:LANE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2606 N SOSSAMAN RD
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85207-1124
Mailing Address - Country:US
Mailing Address - Phone:480-223-7682
Mailing Address - Fax:
Practice Address - Street 1:1076 W CHANDLER BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-5225
Practice Address - Country:US
Practice Address - Phone:480-821-1997
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-18
Last Update Date:2009-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7952225100000X, 2251P0200X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic