Individual
LARRY DEAN LANE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
2829 BABCOCK RD STE 700, SAN ANTONIO, TX 78229-6015
(210) 396-5270
(210) 396-5271
Mailing address
26046 LAUREL PASS, SAN ANTONIO, TX 78260-2474
(916) 798-4823
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2072503
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2072503
TEXAS BOARD OF PHYSICAL THERAPY EXAMINERS
TX
Enumeration date
10/28/2020
Last updated
10/28/2020
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