Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.
MR. JACK LANE IV, PTA
Active Sole ProprietorMR. JACK LANE IV, PTA is a Skilled Nursing Facility healthcare provider located in LEWISTON, Idaho. NPI 1275902520 is currently active in the NPPES registry. Verify at CMS.
Skilled Nursing Facility · LEWISTON, ID
Registration Details
- NPI Number
- 1275902520
- Provider Type
- Individual
- Gender
- Male
- NPI Issued
- Sep 16, 2015 (10.886492743336 yrs)
- Last Updated
- Sep 16, 2015
- License
-
PTA-3672 (ID)
- Sole Proprietor
- Yes
Practice Information
- Address
-
615 29TH STLEWISTON, ID, 835013341Browse ID providers · Browse ZIP 83501
- Phone
- 2089854722
- Primary Specialty
-
Skilled Nursing Facility
314000000X
Data sourced from the NPPES National Provider Identifier registry. This information is for informational purposes only and is not a substitute for verifying credentials with the appropriate licensing authority. For official verification, use the NPPES NPI Registry or the relevant state medical board.