Provider Demographics
NPI:1407159643
Name:LANGE, KARL JOSEPH (PT)
Entity Type:Individual
Prefix:MR
First Name:KARL
Middle Name:JOSEPH
Last Name:LANGE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12616 NE 119TH ST
Mailing Address - Street 2:D7
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-4151
Mailing Address - Country:US
Mailing Address - Phone:520-591-7117
Mailing Address - Fax:
Practice Address - Street 1:12616 NE 119TH ST
Practice Address - Street 2:D7
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-4151
Practice Address - Country:US
Practice Address - Phone:520-591-7117
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-09
Last Update Date:2010-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00009270225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist