Provider Demographics
NPI:1871619262
Name:LANE, ABBY M (PT)
Entity type:Individual
Prefix:
First Name:ABBY
Middle Name:M
Last Name:LANE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:30251 LAUREL PL
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:MO
Mailing Address - Zip Code:63552-3802
Mailing Address - Country:US
Mailing Address - Phone:660-385-1374
Mailing Address - Fax:
Practice Address - Street 1:2005 N. MISSOURI ST.
Practice Address - Street 2:SUITE D
Practice Address - City:MACON
Practice Address - State:MO
Practice Address - Zip Code:63552-0387
Practice Address - Country:US
Practice Address - Phone:660-385-6540
Practice Address - Fax:660-385-6542
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2009-07-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO112589225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
990001817Medicare UPIN