Provider Demographics
NPI:1841410636
Name:LANE, CONNIE ENGLERT (PT, CHT)
Entity Type:Individual
Prefix:MRS
First Name:CONNIE
Middle Name:ENGLERT
Last Name:LANE
Suffix:
Gender:F
Credentials:PT, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2932 BRECKENRIDGE LN
Mailing Address - Street 2:SUITE 10
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40220-1409
Mailing Address - Country:US
Mailing Address - Phone:502-895-3972
Mailing Address - Fax:502-897-5299
Practice Address - Street 1:2932 BRECKENRIDGE LN
Practice Address - Street 2:SUITE 10
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40220-1409
Practice Address - Country:US
Practice Address - Phone:502-895-3972
Practice Address - Fax:502-897-5299
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2010-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY000468225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY01233001OtherMEDICARE PTAN
KY01233001OtherMEDICARE PTAN