Provider Demographics
NPI:1770750051
Name:LANE, CATHERINE LOUISE (LMT)
Entity type:Individual
Prefix:MS
First Name:CATHERINE
Middle Name:LOUISE
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 1:109 ROY ST
Mailing Address - Street 2:
Mailing Address - City:N MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-1630
Mailing Address - Country:US
Mailing Address - Phone:516-249-2136
Mailing Address - Fax:
Practice Address - Street 1:109 ROY ST
Practice Address - Street 2:
Practice Address - City:N MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-1630
Practice Address - Country:US
Practice Address - Phone:516-509-2363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-14
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY27 020862225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist