Individual
MR. TOM LANE III
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
1475 EDGEWOO DRIVE, APT 4B, LIMA, OH 45805
(419) 302-1870
Mailing address
1475 EDGEWOOD DRIVE, APARTMENT 4B, LIMA, OH 45805
(419) 302-1870
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT-770
OH
Other
Enumeration date
05/20/2008
Last updated
05/20/2008
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