Individual
MRS. AMANDA DICKERSON LANE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
23663
AL
225100000X
Physical Therapist
Primary
PTH4985
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
510I650199
MEDICARE PTAN
AL
01
—
51593961
BLUE CROSS
AL
01
—
55#
TRICARE SOUTH REG.
AL
01
—
DB3969
PALMELTO DBA RAIL ROAD MEDICARE
AL
Enumeration date
09/05/2008
Last updated
10/27/2023
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