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1497065007
STACEY MARIE LANE
CHICAGO, IL
NPI
1497065007
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Former Name
STACEY MARIE REIMER
Entity Type
Individual
Gender
Female
Sole Proprietor ?
Yes
Primary Taxonomy
225100000X Physical Therapist
(Licence: IL 070018155)
Enumeration Date
2010-10-15
Last Update Date
2010-10-15
Business Address
-- STACEY MARIE LANE DPT
345 E SUPERIOR ST
CHICAGO, IL 60611-2654
Phone number: 312-238-1000
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Mailing Address
-- STACEY MARIE LANE DPT
1115 MISTWOOD LN
DOWNERS GROVE, IL 60515-1215
Phone number:
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