Provider Demographics
NPI:1578247268
Name:LANGE, PAUL (ATC, DPT)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:LANGE
Suffix:
Gender:M
Credentials:ATC, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 E EMBASSY ST
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85288-1315
Mailing Address - Country:US
Mailing Address - Phone:904-710-8026
Mailing Address - Fax:
Practice Address - Street 1:8701 S HARDY DR
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85284-2800
Practice Address - Country:US
Practice Address - Phone:603-379-0101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-13
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZATTL-0004092255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer