Individual
MARK LANE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
124 S WEST ST, ALEXANDRIA, VA 22314-2825
(703) 299-3100
Mailing address
5370 10TH ST N, ARLINGTON, VA 22205-2402
(703) 528-9616
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2305203221
VA
225100000X
Physical Therapist
PT00002225
WA
Other
Enumeration date
05/24/2007
Last updated
07/08/2007
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