Provider Demographics
NPI:1417315805
Name:LANE, ANDREW (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:
Last Name:LANE
Suffix:
Gender:M
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 5718
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59903-5718
Mailing Address - Country:US
Mailing Address - Phone:855-456-7146
Mailing Address - Fax:406-309-2579
Practice Address - Street 1:1250 BAKER AVE STE 1
Practice Address - Street 2:
Practice Address - City:WHITEFISH
Practice Address - State:MT
Practice Address - Zip Code:59937-2955
Practice Address - Country:US
Practice Address - Phone:406-862-5033
Practice Address - Fax:406-862-4933
Is Sole Proprietor?:No
Enumeration Date:2016-02-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43542225100000X
MT12943225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist