Provider Demographics
NPI:1508809278
Name:LORANG, TIMOTHY KENNETH (PTA)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:KENNETH
Last Name:LORANG
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 252
Mailing Address - Street 2:
Mailing Address - City:FORT HARRISON
Mailing Address - State:MT
Mailing Address - Zip Code:59636-0252
Mailing Address - Country:US
Mailing Address - Phone:406-447-7708
Mailing Address - Fax:
Practice Address - Street 1:1892 WILLIAMS STREET
Practice Address - Street 2:PHYSICAL THERAPY DEPT.
Practice Address - City:FORT HARRISON
Practice Address - State:MT
Practice Address - Zip Code:59636-0252
Practice Address - Country:US
Practice Address - Phone:406-447-7708
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1586PTA225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant