Provider Demographics
NPI:1629137930
Name:LANG, KERRI A (MSPT)
Entity Type:Individual
Prefix:MS
First Name:KERRI
Middle Name:A
Last Name:LANG
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 BLUEBERRY WAY
Mailing Address - Street 2:
Mailing Address - City:PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01960-4941
Mailing Address - Country:US
Mailing Address - Phone:781-696-1024
Mailing Address - Fax:
Practice Address - Street 1:245 NORTH ST
Practice Address - Street 2:
Practice Address - City:STONEHAM
Practice Address - State:MA
Practice Address - Zip Code:02180-2109
Practice Address - Country:US
Practice Address - Phone:781-438-7221
Practice Address - Fax:781-438-7208
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10393225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA616931OtherHARVARD PILGRIM HEALTH
MAY68559OtherBLUE CROSS BLUE SHIELD
MA0403087537OtherPRIVATE
MA470211OtherTUFTS HEALTH PLAN
MA616931OtherHARVARD PILGRIM HEALTH