Provider Demographics
NPI:1760853287
Name:LANEO, MELANIE (DPT)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:
Last Name:LANEO
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:MELANIE
Other - Middle Name:
Other - Last Name:GOUGH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPT
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:630-296-2222
Mailing Address - Fax:630-759-9510
Practice Address - Street 1:1505 WIGWAM PKWY
Practice Address - Street 2:SUITE 240
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-8194
Practice Address - Country:US
Practice Address - Phone:702-568-0195
Practice Address - Fax:702-568-0365
Is Sole Proprietor?:No
Enumeration Date:2015-10-09
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV3191225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist