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Individual

MR. CAMERON A LANE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
DPT

Contact information

Practice address
3016 W. MAIN STREET, SUITE 200, RUSSELLVILLE, AR 72801-2453
(479) 967-9657
(479) 967-9658
Mailing address
3016 W. MAIN STREET, SUITE 200, RUSSELLVILLE, AR 72801-2453
(479) 967-9657
(479) 967-9658

Taxonomy

Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT1836
AR

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
136073721
AR
05
136075742
AR
Enumeration date
07/08/2005
Last updated
11/01/2011
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