Provider Demographics
NPI:1235859166
Name:LANE, THOMAS JULIAN (PT DPT)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:JULIAN
Last Name:LANE
Suffix:
Gender:M
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 1:111 FOX ROAD
Mailing Address - Street 2:STE 101
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37922-9000
Mailing Address - Country:US
Mailing Address - Phone:865-351-0615
Mailing Address - Fax:865-622-9566
Practice Address - Street 1:111 FOX ROAD
Practice Address - Street 2:STE 101
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37922-9000
Practice Address - Country:US
Practice Address - Phone:865-351-0615
Practice Address - Fax:865-622-9566
Is Sole Proprietor?:No
Enumeration Date:2022-08-31
Last Update Date:2024-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN14391225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN14391OtherLICENSE