Individual
LANE THOMAS LACLAIR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT, CSCS, NSCA-CPT
Contact information
Practice address
1201 MAIN ST, UNION GROVE, WI 53182-1303
(262) 878-9602
(262) 878-9609
Mailing address
1201 MAIN ST, UNION GROVE, WI 53182-1303
(262) 878-9602
(262) 878-9609
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
9917024
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40384500
—
WI
Enumeration date
05/17/2006
Last updated
12/19/2015
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