Provider Demographics
NPI:1700499860
Name:LANE, ANDREA NEAL (LMT)
Entity Type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:NEAL
Last Name:LANE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33870 POLAR ST
Mailing Address - Street 2:
Mailing Address - City:SOLDOTNA
Mailing Address - State:AK
Mailing Address - Zip Code:99669-9251
Mailing Address - Country:US
Mailing Address - Phone:907-260-4844
Mailing Address - Fax:
Practice Address - Street 1:33870 POLAR ST
Practice Address - Street 2:
Practice Address - City:SOLDOTNA
Practice Address - State:AK
Practice Address - Zip Code:99669-9251
Practice Address - Country:US
Practice Address - Phone:907-260-4844
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-28
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK139875225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty