Provider Demographics
NPI:1477817047
Name:LANG, ANNA L (DPT)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:L
Last Name:LANG
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 ASH ST
Mailing Address - Street 2:
Mailing Address - City:SPOONER
Mailing Address - State:WI
Mailing Address - Zip Code:54801-1487
Mailing Address - Country:US
Mailing Address - Phone:715-635-3979
Mailing Address - Fax:715-635-3990
Practice Address - Street 1:112 ASH ST
Practice Address - Street 2:
Practice Address - City:SPOONER
Practice Address - State:WI
Practice Address - Zip Code:54801
Practice Address - Country:US
Practice Address - Phone:715-635-3979
Practice Address - Fax:715-635-3990
Is Sole Proprietor?:No
Enumeration Date:2012-06-28
Last Update Date:2018-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN10350225100000X
WI12047-024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1477817047Medicaid
800500014Medicare PIN
WI1477817047Medicaid