Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Mr. Jack Lane IV, PTA

Individual provider Skilled Nursing Facility · NPI 1275902520

Mr. Jack Lane IV, PTA is a Skilled Nursing Facility in Lewiston, Idaho. Practices as a sole proprietor. Licensed in Idaho.

Licensed in
ID
In the registry since
2015
What do these letters mean?
PTA — Physical Therapist Assistant
Delivers treatment under a physical therapist's direction.

See every abbreviation used in this directory →

Claim this listing Report a problem Suggest an edit

Practice location Address checks out

615 29th St
Lewiston, ID 83501-3341
Phone: (208) 985-4722
Show map & directions

Directions in Google Maps · Apple Maps · OpenStreetMap

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Skilled Nursing Facility (primary) Taxonomy 314000000X · Licence PTA-3672 (ID)

Record details

NPI number1275902520
Entity typeIndividual (Type 1)
GenderMale
Credentials PTA
Sole proprietorYes
NPI enumeratedSeptember 16, 2015
Last updated in NPPESSeptember 16, 2015

Other providers in Lewiston