Provider Demographics
NPI:1871850586
Name:LANE, CHRISTINA NADEAN (LMT)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:NADEAN
Last Name:LANE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10045 N EDISON ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97203-1410
Mailing Address - Country:US
Mailing Address - Phone:503-718-1963
Mailing Address - Fax:503-396-5936
Practice Address - Street 1:52515 COLUMBIA RIVER HIGHWAY
Practice Address - Street 2:
Practice Address - City:SCAPPOOSE
Practice Address - State:OR
Practice Address - Zip Code:97051
Practice Address - Country:US
Practice Address - Phone:503-543-2444
Practice Address - Fax:503-396-5936
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-19
Last Update Date:2012-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR18547225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist