Provider Demographics
NPI:1013461185
Name:LANE, DENISE MARIE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:MARIE
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 1:4482 BARRANCA PKWY STE 195
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92604-4706
Mailing Address - Country:US
Mailing Address - Phone:949-679-3337
Mailing Address - Fax:949-679-3336
Practice Address - Street 1:4482 BARRANCA PKWY STE 195
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92604-4706
Practice Address - Country:US
Practice Address - Phone:949-679-3337
Practice Address - Fax:949-679-3336
Is Sole Proprietor?:No
Enumeration Date:2016-08-06
Last Update Date:2019-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT291801225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist