Provider Demographics
NPI:1568834679
Name:LANG, MARK (PT, LMT, CPT)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:LANG
Suffix:
Gender:M
Credentials:PT, LMT, CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10061 HOUGH PT
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80134-9535
Mailing Address - Country:US
Mailing Address - Phone:512-293-9403
Mailing Address - Fax:
Practice Address - Street 1:10061 HOUGH PT
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80134-9535
Practice Address - Country:US
Practice Address - Phone:512-293-9403
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-28
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL.0012992225100000X
TX1083764225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist