Provider Demographics
NPI:1174183354
Name:LANE, BRET D (DPT)
Entity type:Individual
Prefix:DR
First Name:BRET
Middle Name:D
Last Name:LANE
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3210 JENKS AVE
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-4224
Mailing Address - Country:US
Mailing Address - Phone:850-763-0603
Mailing Address - Fax:
Practice Address - Street 1:3210 JENKS AVE
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-4224
Practice Address - Country:US
Practice Address - Phone:850-763-0603
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-19
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVPT004139225100000X
FLPT37197225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPT37197OtherFLORIDA BOARD OF PHYSICAL THERAPY
WVPT004139OtherWV BOARD OF PHYSICAL THERAPY