Provider Demographics
NPI:1285831842
Name:BELANGIA, LANE KEYES (PTA)
Entity Type:Individual
Prefix:MR
First Name:LANE
Middle Name:KEYES
Last Name:BELANGIA
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21301 COUNTY ROAD 18
Mailing Address - Street 2:
Mailing Address - City:WALHONDING
Mailing Address - State:OH
Mailing Address - Zip Code:43843-9717
Mailing Address - Country:US
Mailing Address - Phone:740-327-2402
Mailing Address - Fax:
Practice Address - Street 1:1451 GAMBIER RD
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:OH
Practice Address - Zip Code:43050-9112
Practice Address - Country:US
Practice Address - Phone:740-502-0693
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03394225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant