Provider Demographics
NPI:1083740856
Name:LANGE, REBECCA DYANN (MPT)
Entity Type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:DYANN
Last Name:LANGE
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3001 PARKHAVEN DR.
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75022
Mailing Address - Country:US
Mailing Address - Phone:214-729-3845
Mailing Address - Fax:972-906-7394
Practice Address - Street 1:3001 PARKHAVEN DR
Practice Address - Street 2:
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75022-7847
Practice Address - Country:US
Practice Address - Phone:214-729-3845
Practice Address - Fax:972-906-7394
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1069037225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist