Individual
BRELAN J LANE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
495 YELLOWSTONE AVE, SUITE A, POCATELLO, ID 83201-4531
(208) 232-9198
(208) 232-9168
Mailing address
1560 S CAROL ST, MERIDIAN, ID 83646-1839
(208) 288-1155
(208) 288-0424
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT-3257
ID
Other
Enumeration date
08/20/2013
Last updated
08/20/2013
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