Provider Demographics
NPI:1275606295
Name:LANGE, BRYAN SCOTT (PT)
Entity Type:Individual
Prefix:MR
First Name:BRYAN
Middle Name:SCOTT
Last Name:LANGE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
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Mailing Address - Street 1:2074 ANTILLEY RD STE 100
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79606-5209
Mailing Address - Country:US
Mailing Address - Phone:325-690-9700
Mailing Address - Fax:325-690-9704
Practice Address - Street 1:2074 ANTILLEY RD
Practice Address - Street 2:SUITE 100
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79606-5209
Practice Address - Country:US
Practice Address - Phone:325-437-1219
Practice Address - Fax:325-437-1250
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2011-03-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TX1154950225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist