Provider Demographics
NPI:1659797728
Name:CROUCH, LANIA JANE (LMT)
Entity Type:Individual
Prefix:MRS
First Name:LANIA
Middle Name:JANE
Last Name:CROUCH
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 1:2003 YORKSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-3135
Mailing Address - Country:US
Mailing Address - Phone:407-960-4153
Mailing Address - Fax:
Practice Address - Street 1:515 N PARK AVE
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-3242
Practice Address - Country:US
Practice Address - Phone:407-960-4153
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-12
Last Update Date:2014-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA68515225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist