Provider Demographics
NPI:1992773170
Name:LANE, LINDA ROSS (PT)
Entity type:Individual
Prefix:MS
First Name:LINDA
Middle Name:ROSS
Last Name:LANE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:41485 LORE DR
Mailing Address - Street 2:
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-2092
Mailing Address - Country:US
Mailing Address - Phone:586-530-6482
Mailing Address - Fax:
Practice Address - Street 1:45660 SCHOENHERR RD
Practice Address - Street 2:
Practice Address - City:SHELBY TWP
Practice Address - State:MI
Practice Address - Zip Code:48315-6033
Practice Address - Country:US
Practice Address - Phone:586-566-3050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2007-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501002216225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist