JACK LANE, PTA

PTA

Skilled Nursing Facility

NPI: 1275902520Individual

Specialties, Licenses & Credentials

Skilled Nursing FacilityPrimary

Skilled Nursing Facility

Code: 314000000X

PTA-3672(ID)

Contact & Hours

Address: 615 29TH ST
LEWISTON, ID 83501
Phone: (208) 985-4722

Location

Practice Location

615 29TH ST, LEWISTON, ID

Quick Facts

NPI: 1275902520
Entity Type: Individual
Gender: Male
Medicare: Not confirmed
Specialties: 1
Locations: 1

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