Provider Demographics
NPI:1346532488
Name:LANGE, KERRI LEIGH (MPT)
Entity Type:Individual
Prefix:MRS
First Name:KERRI
Middle Name:LEIGH
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 1:105 BOEHM DR
Mailing Address - Street 2:
Mailing Address - City:SHINER
Mailing Address - State:TX
Mailing Address - Zip Code:77984-6288
Mailing Address - Country:US
Mailing Address - Phone:361-594-8301
Mailing Address - Fax:361-594-3033
Practice Address - Street 1:105 BOEHM DR
Practice Address - Street 2:
Practice Address - City:SHINER
Practice Address - State:TX
Practice Address - Zip Code:77984-6288
Practice Address - Country:US
Practice Address - Phone:361-594-8301
Practice Address - Fax:361-594-3033
Is Sole Proprietor?:No
Enumeration Date:2011-05-09
Last Update Date:2011-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1113132225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist