Provider Demographics
NPI:1639755499
Name:LANE, JIHANNA
Entity Type:Individual
Prefix:
First Name:JIHANNA
Middle Name:
Last Name:LANE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1268 HAMLET RD
Mailing Address - Street 2:
Mailing Address - City:RED HOUSE
Mailing Address - State:VA
Mailing Address - Zip Code:23963-6315
Mailing Address - Country:US
Mailing Address - Phone:434-664-9400
Mailing Address - Fax:
Practice Address - Street 1:1268 HAMLET RD
Practice Address - Street 2:
Practice Address - City:RED HOUSE
Practice Address - State:VA
Practice Address - Zip Code:23963-6315
Practice Address - Country:US
Practice Address - Phone:434-664-9400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-22
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01260038232255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer