Provider Demographics
NPI:1013436690
Name:LANE, CATHERINE AMY (MS, PT)
Entity type:Individual
Prefix:MRS
First Name:CATHERINE
Middle Name:AMY
Last Name:LANE
Suffix:
Gender:F
Credentials:MS, PT
Other - Prefix:MISS
Other - First Name:CATHERINE
Other - Middle Name:AMY
Other - Last Name:SMALLWOOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16254 COMANCHE AVE
Mailing Address - Street 2:
Mailing Address - City:GREENWELL SPRINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70739-6205
Mailing Address - Country:US
Mailing Address - Phone:225-306-5195
Mailing Address - Fax:
Practice Address - Street 1:16254 COMANCHE AVE
Practice Address - Street 2:
Practice Address - City:GREENWELL SPRINGS
Practice Address - State:LA
Practice Address - Zip Code:70739-6205
Practice Address - Country:US
Practice Address - Phone:225-306-5195
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-14
Last Update Date:2017-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA07775R225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist