Provider Demographics
NPI:1528180072
Name:LANG, SUSAN A (PTA)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:A
Last Name:LANG
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:164 PHILIP DRIVE
Mailing Address - Street 2:
Mailing Address - City:FALL RIVER
Mailing Address - State:NOVA SCOTIA
Mailing Address - Zip Code:B2T1H7
Mailing Address - Country:CA
Mailing Address - Phone:902-860-0313
Mailing Address - Fax:902-860-2342
Practice Address - Street 1:7540 N 19TH AVE STE 200
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85021-7967
Practice Address - Country:US
Practice Address - Phone:188-887-3422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA08090225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant