Provider Demographics
NPI:1275757866
Name:LANGE, LANA DALTON (PT)
Entity Type:Individual
Prefix:MRS
First Name:LANA
Middle Name:DALTON
Last Name:LANGE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1384 COUNTY ROAD 262
Mailing Address - Street 2:
Mailing Address - City:ADVANCE
Mailing Address - State:MO
Mailing Address - Zip Code:63730-9031
Mailing Address - Country:US
Mailing Address - Phone:573-331-5153
Mailing Address - Fax:573-331-5028
Practice Address - Street 1:150 S MOUNT AUBURN RD
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63703-4910
Practice Address - Country:US
Practice Address - Phone:573-331-5153
Practice Address - Fax:573-331-5028
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO103565225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist