Provider Demographics
NPI:1720633688
Name:LANE, KRISTEN HUBBARD (PT)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:HUBBARD
Last Name:LANE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:142 SPORTSMAN ISLAND DR STE E
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29492-8524
Mailing Address - Country:US
Mailing Address - Phone:843-696-2174
Mailing Address - Fax:
Practice Address - Street 1:142 SPORTSMAN ISLAND DR STE E
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29492-8524
Practice Address - Country:US
Practice Address - Phone:843-696-2174
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-07
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics