Individual
LANE DIANNE THAXTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
234 JONESBORO RD, MCDONOUGH, GA 30253-3720
(770) 954-9631
Mailing address
2487 BIRDIE RD, GRIFFIN, GA 30223-6317
(706) 604-2906
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA12142
AL
Other
Enumeration date
02/19/2025
Last updated
02/19/2025
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