Provider Demographics
NPI:1528209194
Name:MCLANE, ROBERT DWAINE II
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:DWAINE
Last Name:MCLANE
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:942 SW 6TH ST STE G
Mailing Address - Street 2:
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97526-2900
Mailing Address - Country:US
Mailing Address - Phone:541-472-1799
Mailing Address - Fax:541-472-1699
Practice Address - Street 1:942 SW 6TH ST STE G
Practice Address - Street 2:
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97526-2900
Practice Address - Country:US
Practice Address - Phone:541-472-1799
Practice Address - Fax:541-472-1699
Is Sole Proprietor?:No
Enumeration Date:2009-03-11
Last Update Date:2009-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR7848225200000X
OR4742225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist