Provider Demographics
NPI:1790243624
Name:LANE, KARA JULIANN (PT,DPT)
Entity Type:Individual
Prefix:
First Name:KARA
Middle Name:JULIANN
Last Name:LANE
Suffix:
Gender:F
Credentials:PT,DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 356
Mailing Address - Street 2:
Mailing Address - City:BURTONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20866-0356
Mailing Address - Country:US
Mailing Address - Phone:301-421-1125
Mailing Address - Fax:301-500-2175
Practice Address - Street 1:7130 MINSTREL WAY STE L110
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-5201
Practice Address - Country:US
Practice Address - Phone:240-841-2639
Practice Address - Fax:240-554-2410
Is Sole Proprietor?:No
Enumeration Date:2019-03-11
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD27346225100000X
TN12676225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist