Provider Demographics
NPI:1447560909
Name:LANE, SIOBHAN MEAGAN (LMT)
Entity Type:Individual
Prefix:
First Name:SIOBHAN
Middle Name:MEAGAN
Last Name:LANE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:365 HARRY L DR
Mailing Address - Street 2:STE. C AND D
Mailing Address - City:JOHNSON CITY
Mailing Address - State:NY
Mailing Address - Zip Code:13790-1471
Mailing Address - Country:US
Mailing Address - Phone:607-644-2823
Mailing Address - Fax:607-238-1556
Practice Address - Street 1:365 HARRY L DR
Practice Address - Street 2:STE. C AND D
Practice Address - City:JOHNSON CITY
Practice Address - State:NY
Practice Address - Zip Code:13790-1471
Practice Address - Country:US
Practice Address - Phone:607-644-2823
Practice Address - Fax:607-238-1556
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-18
Last Update Date:2010-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022978-1225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist