Provider Demographics
NPI:1073762019
Name:LANG, LISA E (DPT)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:E
Last Name:LANG
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 WESTHILL DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54401-4705
Mailing Address - Country:US
Mailing Address - Phone:715-847-2827
Mailing Address - Fax:715-847-2048
Practice Address - Street 1:3200 WESTHILL DR
Practice Address - Street 2:SUITE 100
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401-4705
Practice Address - Country:US
Practice Address - Phone:715-847-2827
Practice Address - Fax:715-847-2048
Is Sole Proprietor?:No
Enumeration Date:2008-09-15
Last Update Date:2008-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11052-024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist