| Doctor Name: | KEVIN DANIEL LANE |
| NPI Number: | 1124056536 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PT |
| License Number: | PT20980 |
| Business Practice Address: | 6735 Herndon Pl Suite A Stockton, CA - 952193514 |
| Business Phone Number: | 2099520470 |
| Business Fax Number: | 2099520472 |
| Mailing Address: | 805 Aerovista Pl, Suite 201 SAN LUIS OBISPO |
| State: | CA |
| Postal Code: | 934017919 |
| Phone Number: | 8057880805 |
| Fax Number: | 8057880845 |
| NPI Enumeration Date: | 06/28/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | PT20980 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |