Provider Demographics
NPI:1619211810
Name:LANG, AMBER N (PTA)
Entity Type:Individual
Prefix:MRS
First Name:AMBER
Middle Name:N
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 1:12803 LENOVER ST
Mailing Address - Street 2:
Mailing Address - City:DILLSBORO
Mailing Address - State:IN
Mailing Address - Zip Code:47018-9418
Mailing Address - Country:US
Mailing Address - Phone:812-432-5226
Mailing Address - Fax:812-432-3912
Practice Address - Street 1:12803 LENOVER ST
Practice Address - Street 2:
Practice Address - City:DILLSBORO
Practice Address - State:IN
Practice Address - Zip Code:47018-9418
Practice Address - Country:US
Practice Address - Phone:812-432-5226
Practice Address - Fax:812-432-3912
Is Sole Proprietor?:No
Enumeration Date:2012-11-12
Last Update Date:2012-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN06004359A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant