Provider Demographics
NPI:1710689674
Name:LANE, MEREDITH (DPT)
Entity Type:Individual
Prefix:
First Name:MEREDITH
Middle Name:
Last Name:LANE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:323 NASHVILLE DR
Mailing Address - Street 2:
Mailing Address - City:ARCHER LODGE
Mailing Address - State:NC
Mailing Address - Zip Code:27527-6569
Mailing Address - Country:US
Mailing Address - Phone:919-538-6223
Mailing Address - Fax:
Practice Address - Street 1:3501 SENIOR VILLAGE LN NW
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27896-9618
Practice Address - Country:US
Practice Address - Phone:252-243-3186
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-21
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP17905225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist