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Individual

SHANNON R LANE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
ATC

Contact information

Practice address
36 CRAWFORDS CORNER RD, HOLMDEL HIGH SCHOOL, HOLMDEL, NJ 07733-1908
(732) 946-1876
(732) 946-8641
Mailing address
36 CRAWFORDS CORNER RD, HOLMDEL HIGH SCHOOL, HOLMDEL, NJ 07733-1908
(732) 946-1876
(732) 946-8641

Taxonomy

Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
25MT00137600
NJ

Other

Enumeration date
05/01/2008
Last updated
05/01/2008
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