Individual
JESSICA MAY CANTU-LANE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
5618H OX RD, FAIRFAX STATION, VA 22039-1018
(703) 426-4949
Mailing address
1301 SUMMER LEE DR, ROCKWALL, TX 75032-5452
(972) 771-8111
(972) 771-8103
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2127726
TX
225200000X
Physical Therapy Assistant
2306602886
VA
225200000X
Physical Therapy Assistant
6393
TN
Other
Enumeration date
10/28/2010
Last updated
03/21/2018
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