Provider Demographics
NPI:1942550744
Name:LANE, CHENTELLE MONIQUE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:CHENTELLE
Middle Name:MONIQUE
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 1:16600 W SPRAGUE RD
Mailing Address - Street 2:SUITE NUMBER 365
Mailing Address - City:MIDDLEBURG HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44130-6318
Mailing Address - Country:US
Mailing Address - Phone:216-227-7700
Mailing Address - Fax:
Practice Address - Street 1:16600 W SPRAGUE RD
Practice Address - Street 2:SUITE NUMBER 365
Practice Address - City:MIDDLEBURG HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44130-6318
Practice Address - Country:US
Practice Address - Phone:216-227-7700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-19
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH012887314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility