Provider Demographics
NPI:1851725683
Name:LANE, DANIEL JAY (PTA)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:JAY
Last Name:LANE
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:DAN
Other - Middle Name:JAY
Other - Last Name:LANE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PTA
Mailing Address - Street 1:3715 SW 29TH ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66614-2107
Mailing Address - Country:US
Mailing Address - Phone:913-565-9030
Mailing Address - Fax:
Practice Address - Street 1:3715 SW 29TH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66614-2107
Practice Address - Country:US
Practice Address - Phone:785-272-1535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-28
Last Update Date:2013-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS14-02526225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant