Individual
CAROL J LANE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
890 HAMMOND ST, BANGOR, ME 04401-4328
(207) 992-4042
(207) 992-4043
Mailing address
797 WILSON ST, BREWER, ME 04412-1000
(207) 924-0077
(207) 924-0078
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT1423
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MM759201
MEDICARE PTAN
—
Enumeration date
09/12/2006
Last updated
11/24/2015
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