Individual
BRANDON ALLEN LANE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1423 N JEFFERSON AVE, SPRINGFIELD, MO 65802-1917
(417) 269-8592
Mailing address
404 E HALSEY ST, REPUBLIC, MO 65738-2624
(417) 268-8593
Taxonomy
Speciality
Code
Description
License number
State
2251X0800X
Orthopedic Physical Therapist
Primary
—
—
Other
Enumeration date
05/13/2020
Last updated
05/13/2020
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