Individual
MICHAEL JAMES LANE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
4331 S FREMONT AVE, SPRINGFIELD, MO 65804-7328
(417) 820-5010
Mailing address
3651 S SUNRISE AVE, SPRINGFIELD, MO 65807-0986
(636) 293-4673
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
2013023199
MO
Other
Enumeration date
01/13/2020
Last updated
01/13/2020
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