Provider Demographics
NPI:1922205426
Name:LANE, CHRISTOPHER LAFON (PTA)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:LAFON
Last Name:LANE
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:809 NOLIE RD
Mailing Address - Street 2:
Mailing Address - City:MULLINS
Mailing Address - State:SC
Mailing Address - Zip Code:29574-6033
Mailing Address - Country:US
Mailing Address - Phone:843-496-5417
Mailing Address - Fax:843-777-8165
Practice Address - Street 1:901 E CHEVES ST
Practice Address - Street 2:SUITE 510
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29506-2716
Practice Address - Country:US
Practice Address - Phone:843-777-6357
Practice Address - Fax:843-777-8165
Is Sole Proprietor?:No
Enumeration Date:2007-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1617225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant