Provider Demographics
NPI:1346269974
Name:LANGE, ERIC C (PT)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:C
Last Name:LANGE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3301 BERRYWOOD DR
Mailing Address - Street 2:SUITE 204
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-6517
Mailing Address - Country:US
Mailing Address - Phone:573-449-8771
Mailing Address - Fax:573-449-6563
Practice Address - Street 1:604 EAST BUCHANAN STREET
Practice Address - Street 2:
Practice Address - City:CALIFORNIA
Practice Address - State:MO
Practice Address - Zip Code:65018
Practice Address - Country:US
Practice Address - Phone:573-796-2279
Practice Address - Fax:573-796-2308
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2015-03-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO111260225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist