1942249602 NPI number — MISS CATHERINE S LANE PT, DPT, MS

Table of content: MISS CATHERINE S LANE PT, DPT, MS (NPI 1942249602)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942249602 NPI number — MISS CATHERINE S LANE PT, DPT, MS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LANE
Provider First Name:
CATHERINE
Provider Middle Name:
S
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
PT, DPT, MS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1942249602
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
33 POND AVE
Provider Second Line Business Mailing Address:
APT. 821
Provider Business Mailing Address City Name:
BROOKLINE
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02445-7163
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-899-5977
Provider Business Mailing Address Fax Number:
617-731-9175

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
653 SUMMER ST
Provider Second Line Business Practice Location Address:
SECOND FLOOR
Provider Business Practice Location Address City Name:
BOSTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02210-2108
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-269-6262
Provider Business Practice Location Address Fax Number:
617-269-1068
Provider Enumeration Date:
06/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  1984 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 8211 . This is a "NEIGHBORHOOD HEALTH PLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: UNITED HEALTHCARE . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: Y66576 . This is a "BLUE CROSS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 467875 . This is a "TUFTS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 603413 . This is a "HARVARD PILGRIM" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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