| Lane Physical Therapy Center, Inc | |
|
409 N Elmira Ave, Russellville, AR 72802-9624 | |
| (479) 967-9657 | |
| (479) 967-9658 |
| Full Name | Lane Physical Therapy Center, Inc |
|---|---|
| Type | Facility |
| Speciality | Physical Therapist |
| Location | 409 N Elmira Ave, Russellville, Arkansas |
| Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104855261 | NPI | - | NPPES |
| 136075742 | Medicaid | AR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 225100000X | Physical Therapist | (* (Not Available)) | Primary |
| Provider Name | Stacey B Boster |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1053319715 PECOS PAC ID: 7012186455 Enrollment ID: I20110801000877 |
| Provider Name | Cameron A Lane |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1477551935 PECOS PAC ID: 5193610277 Enrollment ID: I20110913000119 |
| Provider Name | Traci L Steuber |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1689215113 PECOS PAC ID: 1254745789 Enrollment ID: I20210125002387 |
| Provider Name | Jerry W Manning |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1043207525 PECOS PAC ID: 9234253121 Enrollment ID: I20231128002682 |
| Mailing Address | Practice Location Address |
|---|---|
| Lane Physical Therapy Center, Inc 409 N Elmira Ave, Russellville, AR 72802-9624 Ph: (479) 967-9657 | Lane Physical Therapy Center, Inc 409 N Elmira Ave, Russellville, AR 72802-9624 Ph: (479) 967-9657 |
Seth B. Coulter, P.T. Physical Therapist Medicare: Accepting Medicare Assignments Practice Location: 115 Skyline Dr, Suite A, Russellville, AR 72802 Phone: 479-967-5155 Fax: 479-967-5141 | |
Ms. Brandi Nicole Koch, PT, DPT Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 1301 Russell Rd, Russellville, AR 72802 Phone: 479-967-2316 Fax: 479-967-3639 | |
Jacqueline Miller, PT Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 500 E 3rd St, Russellville, AR 72801 Phone: 479-968-1198 Fax: 479-967-1178 | |
Nicholas Paul Lensing, PT Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 301 N Sidney Ave, Russellville, AR 72801 Phone: 479-890-5494 Fax: 479-967-0069 | |
Mr. Jerry Wayne Manning, PT Physical Therapist Medicare: Accepting Medicare Assignments Practice Location: 3016 W Main St Ste 200, Russellville, AR 72801 Phone: 479-967-9657 Fax: 479-967-9658 | |
Kimberly D Mcdougal, PT Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 301 Reasoner Ln, Russellville, AR 72802 Phone: 479-970-2175 Fax: 479-964-2126 | |
Allison Young, P.T. Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 500 E 3rd St, Russellville, AR 72801 Phone: 479-968-1198 |