Provider Demographics
NPI:1558697219
Name:LANG, CHARLES FRED JR (LMT)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:FRED
Last Name:LANG
Suffix:JR
Gender:M
Credentials:LMT
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 5519
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77805-5519
Mailing Address - Country:US
Mailing Address - Phone:832-283-3300
Mailing Address - Fax:
Practice Address - Street 1:4410 COLONY CHASE DR
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77808-7838
Practice Address - Country:US
Practice Address - Phone:832-283-3300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-29
Last Update Date:2009-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT005888225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist