Provider Demographics
NPI:1396483160
Name:LANE, SHELBY (DPT)
Entity type:Individual
Prefix:
First Name:SHELBY
Middle Name:
Last Name:LANE
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1316 E KENTUCKY AVE
Mailing Address - Street 2:
Mailing Address - City:RUSTON
Mailing Address - State:LA
Mailing Address - Zip Code:71270-6609
Mailing Address - Country:US
Mailing Address - Phone:318-224-9081
Mailing Address - Fax:318-224-9083
Practice Address - Street 1:1316 E KENTUCKY AVE
Practice Address - Street 2:
Practice Address - City:RUSTON
Practice Address - State:LA
Practice Address - Zip Code:71270-6609
Practice Address - Country:US
Practice Address - Phone:318-224-9081
Practice Address - Fax:318-224-9083
Is Sole Proprietor?:No
Enumeration Date:2022-05-23
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist