Provider Demographics
NPI:1578642534
Name:KANE, KAREN LYNN (MPT)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:LYNN
Last Name:KANE
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 APPLE VALLEY CIR
Mailing Address - Street 2:
Mailing Address - City:CLARKS SUMMIT
Mailing Address - State:PA
Mailing Address - Zip Code:18411-9498
Mailing Address - Country:US
Mailing Address - Phone:570-586-1051
Mailing Address - Fax:
Practice Address - Street 1:106 APPLE VALLEY CIR
Practice Address - Street 2:
Practice Address - City:CLARKS SUMMIT
Practice Address - State:PA
Practice Address - Zip Code:18411-9498
Practice Address - Country:US
Practice Address - Phone:570-586-1051
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT007763L2251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1857790Medicaid