Individual
SHANNON MARIE LANE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
195 COLLYER ST, PROVIDENCE, RI 02904-1869
(401) 793-4080
Mailing address
195 COLLYER ST, PROVIDENCE, RI 02904-1869
(401) 793-4080
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA 00880
RI
Other
Enumeration date
08/01/2012
Last updated
08/01/2012
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