Provider Demographics
NPI:1790241743
Name:LANE, SHARIN (DPT)
Entity Type:Individual
Prefix:
First Name:SHARIN
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 1:9097 E DESERT COVE AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-6276
Mailing Address - Country:US
Mailing Address - Phone:480-551-4967
Mailing Address - Fax:
Practice Address - Street 1:SPOONER NORTH MESA, PC
Practice Address - Street 2:6824 E BROWN RD # 102
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85207
Practice Address - Country:US
Practice Address - Phone:480-924-5514
Practice Address - Fax:480-924-5518
Is Sole Proprietor?:No
Enumeration Date:2019-02-14
Last Update Date:2019-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist