Provider Demographics
NPI:1477009736
Name:MCLANE, BREANNA (LAT, ATC)
Entity Type:Individual
Prefix:
First Name:BREANNA
Middle Name:
Last Name:MCLANE
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8111 HARRISBURG LN
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27606-7414
Mailing Address - Country:US
Mailing Address - Phone:413-348-1944
Mailing Address - Fax:
Practice Address - Street 1:1219 BROAD ST
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-3577
Practice Address - Country:US
Practice Address - Phone:413-348-1944
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-28
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN36002446A2255A2300X
NCLAT-35832255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer