Provider Demographics
NPI:1013135805
Name:LANE, RENEE TRAHAN (PT)
Entity type:Individual
Prefix:PROF
First Name:RENEE
Middle Name:TRAHAN
Last Name:LANE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:PROF
Other - First Name:RENEE
Other - Middle Name:TRAHAN
Other - Last Name:DAIGLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:1398 E BAYOU PKWY APT C
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-5532
Mailing Address - Country:US
Mailing Address - Phone:337-280-7907
Mailing Address - Fax:337-993-7445
Practice Address - Street 1:1398 E BAYOU PKWY APT C
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-5532
Practice Address - Country:US
Practice Address - Phone:337-280-7907
Practice Address - Fax:337-993-7445
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA00379225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5CR50Medicare ID - Type UnspecifiedGROUP MEDICARE NUMBER
LA4H580Medicare ID - Type UnspecifiedMEDICARE PROVIDER #