Individual
CARISSA LANE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPT
Contact information
Practice address
105 MARINER HEALTH WAY STE 213, ST AUGUSTINE, FL 32086-3251
(904) 217-4259
(904) 217-4251
Mailing address
105 MARINER HEALTH WAY STE 213, ST AUGUSTINE, FL 32086-3251
(904) 217-4259
(904) 217-4251
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
13019
AZ
225100000X
Physical Therapist
Primary
PT36674
FL
Other
Enumeration date
06/18/2018
Last updated
02/16/2021
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